- Tidelands Health (Myrtle Beach, SC)
- …and help people live better lives through better health!** **Provider Coding Specialist ** Are you passionate about quality and committed to excellence? Consider ... Overview** Under the supervision of the Coding Supervisor, the Provider Coding Specialist is responsible for analyzing and assigning ICD-10-CM diagnostic codes, CPT,… more
- Stony Brook University (Stony Brook, NY)
- …to include tracking hours used/taken, sending timely notifications of leave approvals or denials , and working closely with payroll to ensure that pay for employees ... to leaves and time reports. + Collaborate with the Workers' Compensation Specialist on employee leaves related to accidents and injuries. + **Collective Bargaining… more
- Fairview Health Services (St. Paul, MN)
- …the development of denial reports and other statistical reports. + Collaborates with Clinical Denials Nurse Specialist and Leadership in high-dollar claim ... **Job Overview** The Inpatient Coding Denials Specialist performs appropriate efforts to...including but not limited to: DRG downgrade, DRG Validation, Clinical Validation, diagnosis codes not supported, and/or general coding… more
- Northwell Health (Melville, NY)
- …utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness ... Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect… more
- Northwell Health (Melville, NY)
- …utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness ... Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect… more
- Nuvance Health (Danbury, CT)
- …delays in reimbursement. This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to all payers, ... initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within...appeals and communicating on a daily/regular basis with the Denials Management team. * Assists with informing Managed Care… more
- Houston Methodist (Sugar Land, TX)
- …DRG recoupments/downgrades, and denials for no authorization. The Senior Denials Management Specialist position communicates clinical information ... opportunities to both operational and clinical stakeholders. The Senior Denials Management Specialist position collaborates with physicians, case managers,… more
- HCA Healthcare (Ocala, FL)
- …opportunity. We want your knowledge and expertise! **Job Summary and Qualifications** The Clinical Denials Coding Review Specialist is responsible for ... **Introduction** Do you have the career opportunities as a Clinical Denial Coding Review Specialist you want...as it relates to researching, analyzing, and resolving outstanding clinical denials and insurance claims. This job… more
- University of Southern California (Los Angeles, CA)
- …federal & state coding compliance regulations and guidelines, the HIM Coding Denials Management Specialist " analyze, investigate, mitigate, and resolve all ... denials , triage denied claims to distinguish coding-related denials versus clinical -related denials , evaluating...will provide guidance and training to other HIM Coding Denials Management Specialist , and will assist with… more
- Community Health Systems (Franklin, TN)
- … Documentation Improvement Professional required or + CCDS - Certified Clinical Documentation Specialist required Equal Employment Opportunity This organization ... **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits...for accuracy in ICD-10-CM/PCS coding, DRG assignments, and supporting clinical documentation. This includes evaluating present on admission (POA)… more
- Texas Health Resources (Arlington, TX)
- …with a top-notch health care company? We're looking for a qualified_ Coder II ( Denials ) _like you to join our Texas Health family._ Position Highlights + Work ... Certified Professional Coder Upon Hire REQUIRED or CCS-P - Certified Coding Specialist - Physician-based Upon Hire REQUIRED and Other Specialty certification such as… more
- Rochester Regional Health (Rochester, NY)
- …resolve the issues resulting in denial/underpayment and to formally appeal. The specialist will conduct comprehensive reviews of clinical documentation to ... SUMMARY The C & D specialist is responsible for reviewing accounts which have...claims processing and accounts receivable collections. The Medical collection specialist must have the Ability to learn and understand… more
- BJC HealthCare (St. Louis, MO)
- …for resolving clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be able to multi-task and maintain a high level ... Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist with infusion...government and commercial plans. This individual will be handling clinical denials and sending them to a… more
- Covenant Health Inc. (Knoxville, TN)
- …to a friend (https://careers-covenanthealth.icims.com/jobs/67849/cdi- specialist - clinical /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336232841) Job Title CDI ... Monitors activities and findings with regard to audits and denials and subsequently adjusts to potential trends when reported....SPECIALIST CLINICAL ID 4371209 Facility Covenant Health Corporate Department Name Clinical Doc… more
- Covenant Health Inc. (Knoxville, TN)
- …to a friend (https://careers-covenanthealth.icims.com/jobs/67847/cdi- specialist - clinical /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336232841) Job Title CDI ... Monitors activities and findings with regard to audits and denials and subsequently adjusts to potential trends when reported....SPECIALIST CLINICAL ID 4371212 Facility Covenant Health Corporate Department Name Clinical Doc… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …high-cost drug, and off-label drug authorizations. The Clinical Authorization Specialist is also responsible for managing denials related to front-end ... Working in a fast-paced, high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and… more
- Penn Medicine (Philadelphia, PA)
- …each day. Are you living your life's work? Job Title: Accounts Resolution Specialist I Department: Ophth Clinical Support SEI Location: Penn Presbyterian Medical ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
- University of Southern California (Arcadia, CA)
- …Documentation Improvement Practitioner (CDIP) certification status preferred. + Certified Clinical Documentation Specialist (CCDS) credential preferred. Pay ... recommendations on query structure, process, and workflow. Responds to coding denials with clinical justifications and coding conventions. Maintain… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
