- Beth Israel Lahey Health (Plymouth, MA)
- …making a difference in people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who We Are:** At **Beth ... Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs...Reviews and determines appropriate strategy in response to reimbursement denials . + Responsible for appeals and follow… more
- Beth Israel Lahey Health (Burlington, MA)
- …Billing Office. 15. Independently works on the resolution of complex claims issues, denials , and appeals . 16. Completes projects and research as assigned. 17. ... job, you're making a difference in people's lives.** The Denials Specialist 3 role specializes in high-dollar claims, aged...practice, and user trends and makes recommendations to the Manager of Revenue System Operations and partners with the… more
- Beth Israel Lahey Health (Burlington, MA)
- …needs for ICD-9, ICD-10. Works directly with the Billing Supervisor and Coding Manager to resolve complex issues and denials through independent research and ... Billing Supervisor with the resolution of complex claims issues, denials and appeals . 16. Completes projects and...access, web access, or any other means provided by manager . **Organizational Requirements:** 1. Maintain strict adherence to the… more
- Beth Israel Lahey Health (Plymouth, MA)
- …is expanding its **Care Transitions Department** and seeking an experienced ** Manager of Utilization Review & Denials Management** and **Utilization ... for level of care and continued stay * Lead appeals of clinical denials and collaborate with...or other case management certification preferred or in progress ** Manager - Utilization Review & Denials Management**… more
- Beth Israel Lahey Health (Burlington, MA)
- …Billing Office. 20. Independently works on the resolution of complex claims issues, denials , and appeals . 21. Completes projects and research as assigned. 22. ... involve registration error, coverage, and eligibility related front-end edits and denials for both Professional and Hospital Billing. Additional tasks for… more
- State of Massachusetts (Boston, MA)
- …to Pharmacy Benefit Managers and the processing of insured health plans' pharmacy benefit denials and appeals as overseen by OPP. * Participate in meetings with ... citizens. *_About the Role:_* The Director of Pharmacy Benefit Manager Oversight operating within the Health Care Access Bureau...The primary purpose of the Director of Pharmacy Benefit Manager Oversight is to assist the Commissioner of Insurance… more
- Children's Hospital Boston (Boston, MA)
- …authorizations for the appropriate level of care for admissions and with post-discharge appeals of payer denials . They identify and implement initiatives to ... 80451BRJob Posting Title:Per Diem RN Case Manager , Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard Hours per… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …appeal process. + Creates cost estimates for waivers. + Root causes claim denials , reprocesses, and submits claim appeals . + Creates drug cost estimates ... Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient advocate between Dana… more
- Beth Israel Lahey Health (Burlington, MA)
- …Manages UM department in the context of other Revenue Cycle functions such as Denials & Appeals , Patient Access, Authorization Management & review, HIM, Coding & ... Billing. Close collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities for improvement within an interdisciplinary team and integrated Revenue Cycle… more
- Beth Israel Lahey Health (Plymouth, MA)
- …multidisciplinary team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor ... clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient. + Conducts… more