- 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
- 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
- Bon Secours Mercy Health (Toledo, OH)
- …Patient Access staff are responsible for assigning accurate MRNs, completing medical necessity or compliance checks, providing proper patient instructions, ... information, and all other patient information. Responsible for accurately screening of medical necessity using the Advanced Beneficiary Notice (ABN) software to… 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
- Hackensack Meridian Health (Neptune, NJ)
- …with patient status. Facilitates accurate documentation for severity of illness and medical necessity . Interacts with physicians, case managers, and nursing ... Knowledge of POA/HAC and core measures. + Knowledge of Observation and Inpatient medical necessity . + Knowledge of regulatory requirements for appropriateness of… 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
- Medical Mutual of Ohio (Brooklyn, OH)
- …as needed. . Identifies and requests internal/external documentation as needed for medical necessity appeal issues and submit cases to appropriate area ... collective experience, training and education. . 5 years as an Appeals Specialist or equivalent experience in Medicare health insurance claims, customer service,… 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 ... medical policies to resolve denials based on medical necessity . + Researches and applies LCD's....medical specialty environment. Classified Title: AR Revenue Cycle Specialist II Job Posting Title (Working Title): AR Revenue… more
- St. Luke's University Health Network (Allentown, PA)
- …Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks outcomes regarding appeal process. Assists billing staff ... all Inpatient Retroactive Denials in the Denials Management Work Queues for Medical Necessity and Late-Pick-Up/Notification that are entered by Case Management… 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 ... are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR ...want to promote within our team. + Benefits - Medical , Dental, Vision + Flexible Paid Time Off -… 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
- 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
- Granville Health System (Oxford, NC)
- …of clinical documentation for both the physician and the hospital.# #Reviews medical necessity denials and provides constructive feedback to providers.# #Works ... Summary:#The CDI Specialist is responsible for improving the overall quality...severity of illness and intensity of service to ensure medical necessity .# #Collaborates with Coding Team to… more
- Tidelands Health (FL)
- …on coding questions. + Have knowledge of payer guidelines related to MUE, Medical Necessity , LCD/NCD requirements and HIPAA/Compliance in order to take ... HCPCS codes to all outpatient, ED, and hospitalists accounts, based on the medical information provided and consistent with regulatory guidance and best practices in… more