- Cognizant (Hartford, CT)
- …cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... help you stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is a plus. We're excited to meet people… more
- Nuvance Health (Danbury, CT)
- …critical part in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with CMS requirements, ... initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- Nuvance Health (Danbury, CT)
- …Hours 5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, ... and facilitates communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld cases in… more
- Hartford HealthCare (Farmington, CT)
- …. Prepare, document, and submit appeals for DRG denials, ensuring appeals are well-supported with clinical evidence, coding guidelines, and regulatory ... Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS),and/or Certified Clinical Documentation Specialist … more
- Hartford HealthCare (Hartford, CT)
- …Description_* Under the direction of the Manager, a Prior Authorization Specialist performs all clerical duties required to obtain insurance prior authorizations ... and or federal regulatory guidelines to their manager, providers and other clinical departments, as applicable. . Monitors and reviews the prior authorization work… more
- Nuvance Health (Danbury, CT)
- *Description* Summary: The Insurance Reimbursement Specialist is responsible for coordination and support of initiatives relative to the registration functions, ... referrals for service when appropriate. 2. Obtains and understands necessary clinical information (including diagnoses) for registration to initiate requests for… more
- Performance Optimal Health (Stamford, CT)
- …through exceptional care, service, and teamwork. We are seeking a Billing Specialist to join our growing Practice Administration/Billing team. This role combines all ... companies, patients, and internal staff. + Prepare and send appeals when claims are denied or underpaid. + Maintain...comply with HIPAA regulations. + Collaborate with the billing, clinical , and front desk teams to ensure seamless revenue… more
- Trinity Health (Hartford, CT)
- …of occupational medicine clinic patient charges. Communicates effectively with clinical operations and administrative personnel concerning the transmission of ... medical chart documentation for the purposes of bill resubmissions and appeals . Analyzes EOB's (Explanation of Benefits) from payers to determine the accuracy of… more
- Evolent (Hartford, CT)
- …guidance and expertise to ensure the application of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations ... Are you ready to make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular… more