- Sanford Health (SD)
- …$34.50 **Department Details** Work from Home option **Job Summary** Facilitates the denial and appeal process through exercising clinical expertise and clinical ... by reviewing medical records for medical necessity and policy requirements. Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing of appeals as required… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Coding Charges & Denials Specialist is responsible for coordinating and monitoring the coding-specific clinical charges and denial ... risk and exposure caused by front end claim edits and retrospective denial of payments for services provided. This position will collaborate with physicians,… more
- First Horizon Bank (Knoxville, TN)
- …application that the borrower has submitted. + Actions the borrower must take to appeal the modification denial , when applicable. + The circumstances under which ... time. **Position Overview:** The Single Point of Contact (SPOC) Default Servicing Specialist role is responsible for providing delinquent or imminent default real… more
- CaroMont Health (Gastonia, NC)
- …serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal results. Maintains the Status Change Database. ... Performs retrospective clinical reviews/appeals as part of denial process. The UR Specialist will be cross trained to work for the Commercial Resource Analyst… more
- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the ... protocols, policies and strategies within the department I. Partners with Senior Leadership and other stakeholders to achieve strategic objectives through successful… more
- Community Health Systems (Franklin, TN)
- …in the department. + Works with clinics to resolve denials from the clinic denial logs. + Requests additional medical records as needed to clarify missing or ... detected through auditing and monitoring to the department supervisor and the Senior Director of Physician Coding and Documentation. + Ensures assigned projects are… more
- General Dynamics Information Technology (Washington, DC)
- …and initiating staffing for approval. . Coordinating access approval or denial process with appropriate access approval authority. . Preparing documentation to ... notify appropriate personnel of access approval or denial . . Providing advice to the Program Security relating...issues, including the procedures to be followed in the appeal processes. . Providing proper protection for privacy information.… more
- General Dynamics Information Technology (Washington, DC)
- …and initiating staffing for approval. + Coordinating access approval or denial process with appropriate access approval authority. + Preparing documentation to ... notify appropriate personnel of access approval or denial . + Conducting program debriefings and processing of relevant documentation (eg, SAP nondisclosure… more
- Ascension Health (Baltimore, MD)
- …to: Access Authorization and pre-certification, utilization review and denial management, CareCoordination, Collaborative treatment planning and core measures, ... planning, and length of stay. + Serve as content specialist for staff in the areas of utilization criteria,... for staff in the areas of utilization criteria, appeal and review process, and case management system documentation.… more