• Registered Nurse or Physical Therapist…

    CenterWell (Nashville, TN)
    …responding to, managing and monitoring all payer requests for additional documentation (ADR), appeals and denials . Works with branch staff to gather required ... to develop appropriate and timely responses. + Responsible for constructing response to denials and appeals , utilizing any federal guidelines or local coverage… more
    CenterWell (07/30/25)
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  • UR Clinical Specialist

    Community Health Systems (Franklin, TN)
    …management policies. This role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers ... **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating...insurance companies to secure coverage approvals and mitigate concurrent denials by submitting reconsiderations or coordinating peer-to-peer reviews. +… more
    Community Health Systems (07/29/25)
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  • Specialist-Denial II RN

    Baptist Memorial (Memphis, TN)
    …extensive knowledge of payer guidelines and BMHCC contracts as it pertains to authorization and clinical denials as well as clinical audits. + Requires a ... the entire appeal process and determines if escalation to manager or payer is next step to get a...of entry to discharge when responding to technical authorization denials . + Compiles, analyzes, and distributes pertinent clinical… more
    Baptist Memorial (07/11/25)
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  • Coding Spec-Clinic

    Covenant Health Inc. (Knoxville, TN)
    …Business Office personnel to resolve issues related to claims, coding, pre-cert, and denials appeals , and verifies that appropriate chargemaster rates are used. ... and hospital personnel to ensure qualifying diagnosis covers tests/procedures. + Analyzes denials and coordinates appeals . + Ensures corrective action is taken… more
    Covenant Health Inc. (08/04/25)
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