- Cognizant (Boston, MA)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...related to clinical denial management and managing clinical denials from Providers to the Health… more
- Beth Israel Lahey Health (Plymouth, MA)
- … denials . + Responsible for appeals and follow up on clinical denials escalated through a work queue, providing appropriate response supported by ... UR and the analysis, resolution, monitoring & reporting of clinical denials . + Maintains current knowledge of... clinical information. + Provides oversight of the … more
- Beth Israel Lahey Health (Charlestown, MA)
- …important role in a high-profile team tasked with handling all commercial and government clinical appeals and audit processes. The Clinical Analyst will ... to gather information that would support submitted charges. Prepare clinical appeals relevant to the audits in...to Revenue Cycle Leadership. * Perform process review of denials by hospital departments, and provide clinical … more
- Beth Israel Lahey Health (Plymouth, MA)
- … clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient. ... team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding… more
- Beth Israel Lahey Health (Plymouth, MA)
- …concurrent and retrospective reviews for level of care and continued stay * Lead appeals of clinical denials and collaborate with physician advisors * ... understanding of reimbursement systems. You will manage concurrent reviews, appeal clinical denials , and support accurate level-of-care determinations. Key… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. ... high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and… more
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... external review agencies, to coordinate activities involved in medical record review, denials , appeals and reconsideration hearings. Works closely with the… more