- CenterWell (Boise, ID)
- …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
- Molina Healthcare (Meridian, ID)
- …subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing... appeals and denials . + Strong verbal and written communication skills +… more
- St. Luke's Health System (Twin Falls, ID)
- …Clinical Appeals Specialist, is responsible for managing client medical denials by conducting a comprehensive analytic review of clinical documentation to ... sources to provide and maintain a single reporting location that reflects clinical denials and appeals activity. + Recommends improvements and modifications to… more
- Molina Healthcare (Caldwell, ID)
- …subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine Provider No Surprises Act… more
- R1 RCM (Boise, ID)
- …will help support clinicians who conduct a comprehensive review of clinical denials and formulate appeals based on clinical documentation, evidence-based medical ... patient care as well as conceptual knowledge of the denials landscape. Proficiency in basic computer skills is essential...**Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor the workflow of… more
- R1 RCM (Boise, ID)
- …federal laws, writing appeals and letters to insurance companies to resolve denials , and reviewing high-balance or complex accounts. To thrive in this role, you ... a Complex Denials Consultant:** + Assist recovery staff in pursuing appeals , including the development of new and innovative legal and procedural arguments and… more
- Cardinal Health (Boise, ID)
- …in the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials , to ensure timely and accurate reimbursement. + ... Processes denials & rejections for re-submission (billing) in accordance with...changes that may need to be made. + Processes denials & rejections for re-submission (billing) in accordance with… more
- Trinity Health (Nampa, ID)
- …needed and requested by third party payers and Medicaid. + Responsible for appeals , denials , as appropriate. Utilizes physician advisor referral as appropriate. ... + Will adhere to department established process in reviewing 30 day re-admissions. + Follows established patient choice policy. + Documents assessment of primary and back up plans along with communications to patient , family and care team. + Participates in… more
- R1 RCM (Boise, ID)
- …AI, intelligent automation, and workflow orchestration. As our Accounts Receivable & Denials DRG Supervisor, you will be responsible for the appropriate management ... you can expect working as our Accounts Receivable & Denials DRG Supervisor:** + Assist in all training required...accounts. + Review, draft and/or approve complex and contractual appeals and letters to insurance companies. + Manage daily… more
- Intermountain Health (Boise, ID)
- …all pertinent patient related insurance eligibility, benefits, authorization; follow-up on appeals and denials when requested + Contacts patient/provider when ... insurance eligibility, securing prior authorization and managing authorization related denials to ensure patient financial health. **Essential Functions** +… more