- Rick's Medical Supply (Roseburg, OR)
- …Under the general supervision of the Medical Necessity Supervisor, a Medical Necessity Specialist is responsible for maintaining a positive, helpful ... and coverage with the health plan, sending out and obtaining medical necessity documentations in a timely manner. Responsibilities: + Responsible for creating,… more
- Insight Global (Hialeah, FL)
- …coding and a strong understanding of diagnosis coding and medical necessity . The Revenue Integrity Coding Specialist will be accountable to the ... This role involves reviewing queries related to ICD-10CM/PCS and HCPCS/CPT code assignments, medical necessity , abstracted data, or any other elements of coded… more
- Danaher Corporation (Tallahassee, FL)
- …address the world's biggest health challenges. The Senior Informatics Technical Specialist will be Beckman Coulter's front-line contact with customers in delivering ... job include: + Associate degree in science, IT, or medical technology plus 3+ years of related experience in...experience in: + Bachelor's degree in science or preferably Medical Technology in with experience in a laboratory environment… more
- CDPHP (Albany, NY)
- …knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations about ... and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and grievance process that… more
- Carle (Urbana, IL)
- …Represents Carle in clinical meetings and writing appeals on outpatient accounts where medical necessity , level of care or prior authorization is questioned. ... Outpatient Denial/Appeals Specialist - RN + Department: Revenue Cycle - CFH_10_19...Performs outpatient post payment reviews where medical necessity is being challenged. Responsible for… more
- CaroMont Health (Gastonia, NC)
- …with discharge planning specialist and other disciplines. Retrospectively reviews discharged medical record for medical necessity criteria and sends ... Job Summary: Completes initial review for medical necessity for all admissions in...clinical reviews/appeals as part of denial process. The UR Specialist will be cross trained to work for the… more
- Weill Cornell Medical College (New York, NY)
- …billing guidelines to substantiate corrected claim submissions, written appeals, coding and medical necessity reviews. + Researches and interprets payer contract ... Title: Revenue Cycle Specialist -Revenue Integrity (Remote) Location: Midtown Org Unit: AR...documentation review of denied charges for physician services. Reviews medical records for completeness and accuracy to ensure documentation… more
- Houston Methodist (Houston, TX)
- …items that result in resolution. Engages the coding follow up team for any medical necessity or coding related appeals. + Assures accounts are completed and ... At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect...ESSENTIAL FUNCTIONS** + Expedites and maximizes payment of insurance medical claims by contacting third party payers and patients.… more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- …Knowledge of other front-end processes, including scheduling, pre-registration, financial counseling, medical necessity , and registration. + Superb teamwork and ... front-end processes, including scheduling, pre-registration, financial counseling, insurance authorization, medical necessity , and registration. + Superb teamwork… more
- Compass Group, North America (New York, NY)
- …Management, and Ambulatory EVS. Learn more at www.Crothall.com. Job Summary The Medical Device Integration and Cybersecurity specialist will be responsible for ... Utilizing Crothall's cybersecurity framework, technologies and policies and procedures, the Medical Device Integration and Cybersecurity Specialist will be… more
- HCA Healthcare (San Antonio, TX)
- …solving capability.11.Ability to navigate a medical record for determination of medical necessity for an IRF admission.12.Ability to analyze clinical data ... assessments in collaboration with both hospital Case Management and the Rehab Medical Director. The Clinical Rehabilitation Specialist works closely with… more
- Glens Falls Hospital (Glens Falls, NY)
- …and approved for procedure / testing point of service as appropriate . Verify medical necessity guidelines are met and take appropriate action as needed when ... can be found here. **Job:** **Administrative/Clerical* **Title:** *Referral & Authorization Specialist - Cancer Center - Medical Records* **Location:** *NY-Glens… more
- Access Dubuque (Dubuque, IA)
- …the healthcare team, achieves appropriate clinical documentation to support code assignment, medical necessity , severity of illness, risk of mortality and level ... Job TH Ad TH Comments **Similar Jobs** Clinical Assistant - Dermatology Medical Associates Clinical Documentation Specialist MercyOne OR Inventory Specialist… more
- UPMC (Pittsburgh, PA)
- …facility. + Utilize payor-specific criteria or state laws and regulations to determine medical necessity for the clinical appropriateness for a broad scope of ... + Obtain appropriate diagnosis, procedure, and additional service codes to support medical necessity of services being rendered using pertinent medical… more
- Berkshire Health Systems (Pittsfield, MA)
- …validating that the correct code has been used as appropriate following strict medical necessity standards. Will also handle all patient and MD communication, ... + DEFINITION/PRIMARY FUNCTION + The Day Scheduling Specialist receives requests to schedule and place orders for BMC/BFS, North Adams Satellite Office and Fairview… more
- Nightwing (Sterling, VA)
- …TS/SCI with Polygraph clearance crossover. Nightwing is looking for a Logistics Specialist to support a fast-paced rapidly changing high-tech mission in the Northern ... VA area. The Specialist will be embedded within a multi-disciplined team including...and will be required to be obtain a DOT Medical Card, drive Forklifts and be certified for DOT/IATA… more
- Spectrum Billing Solutions (Skokie, IL)
- …Your Responsibilities: + Review patient admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain ... seeking to add an ABA Prior Authorization / UR Specialist to our growing team. The ABA Prior Authorization...want to promote within our team. + Benefits - Medical , Dental, Vision + Flexible Paid Time Off -… more
- SUNY Upstate Medical University (Syracuse, NY)
- …clarify patient documentation and coding requirements; obtaining and providing letters of medical necessity as needed, and coordinating new patient referrals for ... Job Summary: Reporting to the Business Manager, the Outpatient Administrative Specialist is responsible for obtaining insurance referrals and authorizations for… more
- Johns Hopkins University (Middle River, MD)
- … will research and interpret medical policies regarding denials based on medical necessity . Will use a working knowledge of local coverage determinations ... non-standard appeals. + Researches medical policies to resolve denials based on medical necessity . + Researches and applies LCD's. + Resolves issues across… more
- Kelsey-Seybold Clinic (Houston, TX)
- … medical reviews, benefit verification, and applying criteria to determine medical necessity for health care services requiring authorization prior to ... services being rendered for members. The Utilization Review Specialist (LVN) serves as a liaison in reviewing requests...(LVN) serves as a liaison in reviewing requests for medical and surgical procedures, services and admissions. The Utilization… more