- Community Health Systems (Franklin, TN)
- …Analyzes denials to determine appropriate actions, completes appeals , or routes cases for clinical appeals as needed. + Files and monitors appeals to ... **Job Summary** The Denials & Appeals Coordinator is responsible for managing, tracking, and...fast-paced environment. **Licenses and Certifications** + Certified Revenue Cycle Specialist (CRCS) - AAHAM preferred Equal Employment Opportunity This… more
- HCA Healthcare (Brentwood, TN)
- **Description** **Introduction** Do you have the career opportunities as a Clinical Denial Coding Review Specialist you want with your current employer? We have ... are a committed, caring group of colleagues. Do you want to work as a Clinical Denial Coding Review Specialist where your passion for creating positive patient… 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
- Actalent (Chattanooga, TN)
- Job Description We are seeking a detail-oriented and customer-focused Pharmacy Support Specialist to join our team. In this role, you will: + Respond to calls and ... members, and member representatives regarding pharmacy prior authorizations, exceptions, and appeals . + Enter authorizations and test claims into the pharmacy… more
- Actalent (Chattanooga, TN)
- …and/or members/members representatives for pharmacy prior authorizations, exceptions, and appeals Enter authorizations and test claims into the pharmacy benefit ... system to ensure appropriate claim adjudication Perform system edits, data entry, and complete tracking logs Assist with departmental audits and quality improvement activities Skills Pharmacy, Cpht, Call center, PTCB Top Skills Details Pharmacy,Cpht,Call… more
- Wellpath (Franklin, TN)
- …month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We offer ongoing training and ... unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care...support. **How you make a difference** The Fund Control Specialist performs pre- and post-payment audits of external claims;… more
- Community Health Systems (Franklin, TN)
- … Documentation Improvement Professional required or + CCDS - Certified Clinical Documentation Specialist required Equal Employment Opportunity This organization ... records for accuracy in ICD-10-CM/PCS coding, DRG assignments, and supporting clinical documentation. This includes evaluating present on admission (POA) indicators,… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Coding Specialist , Centralized Coding [Type, HPPP, Shift] Covenant Health Overview: Covenant Health is the region's top-performing healthcare network with ... serves as the user advocate between Health Information Management (HIM), Clinical Effectiveness, and Registration. Other job duties include: improving health record… more
- Evolent (Nashville, TN)
- …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
- Community Health Systems (Franklin, TN)
- …authorizations and reduce potential denials, utilizing input from the Utilization Review Clinical Specialist . + Monitors and updates case management software ... and effective management of utilization review processes, including denials and appeals activities. This role collaborates with payers, hospital staff, and … more