- CenterWell (Harrisburg, PA)
- …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
- St. Luke's University Health Network (Allentown, PA)
- …to, physicians, hospital employees and vendors. Advises Network CDI & DRG Denials Manager on issues requiring immediate attention. ADDITIONAL REQUIREMENTS: ... regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding of… more
- Guthrie (Sayre, PA)
- …well as identifies, analyzes and takes the necessary action to submit complex appeals to insurance payers. Reviews all medical chart and account documentation in ... to determine appropriate coding and initiate corrected claims and appeals . Interprets payer guidelines, regulatory guidelines, contractual obligations and works… more
- Highmark Health (Monroeville, PA)
- …and contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials / appeals and retrospective payer audit denials . ... CERTIFICATIONS** **Required** + None **Preferred** + ACM Certification (Accredited Case Manager ) - American Case Management Association - American Case Management… more
- PSKW LLC dba ConnectiveRx LLC (Pittsburgh, PA)
- …resources, regional level and alternative resources. + Assists in obtaining insurance approvals/ denials and/or appeals for therapy. Assists patients and HCP with ... better than the sum of its parts. The Case Manager 's primary duty is to assist customers with chronic...their wellbeing needs, journey and treatment plan. The Case Manager collaborates and maintains consistent communications with internal and… more
- Penn State Health (Hershey, PA)
- …or project management of processes. + Experience in Coding, Billing Denials , Edits, Appeals , Utilization Management, Charge Capture, Compliance/Revenue Cycle ... was needed to optimize charge/cash capture. This position reports to Team Manager Revenue Integrity and the Revenue Integrity Support Services Leadership. **MINIMUM… more
- Genesis Healthcare (York, PA)
- …making a meaningful impact in the communities we serve. Responsibilities The Manager , Case Management is responsible for the clinical, administrative, and financial ... responding to the needs of its payor customers. The Manager will also perform the functions of the Case...for effectively addressing concurrent and retrospective clinical and administrative denials by payors and trains staff on same. 5.… more
- Cognizant (Harrisburg, PA)
- …manage appeals , working with various departments to prevent future denials . + Review documentation to code diagnosis and procedures specific to cardiovascular ... Coding Professional you will be responsible for reviewing/resolving coding denials in the cardiovascular specialty. You will be a...a team in a fast-paced environment. + Interacting with manager /team members on scheduled time off and breaks and… more
- Select Medical (Camp Hill, PA)
- …rendered in a timely manner. This includes making phone calls and writing appeals . Often works with provider representatives at the payers. + Make creative ... and actions taken on individual accounts to Business Office Manager with the goal of making decisions on revenue....analytics tools to identify trends and patterns in claim denials , overpayments, and underpayments. Convey these trends to the… more