- 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
- 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
- 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
- WellSpan Health (Chambersburg, PA)
- …department guidelines of Denials WQ as required. Track, trend and investigate denials with insurance companies. Send appeals when required. Make sure account ... Position Function: Under the direction of the Patient Account Manager , is responsible for the billing of Medicare, Medical Assistance, Blue Cross, Highmark Blue… more
- St. Luke's University Health Network (Allentown, PA)
- …clean claim submission and timely review and resolution of coding related claim denials for professional services, FQHC, MSO, and ASCs across the network. Utilizes ... coding errors and MUE frequency for clean claim submission + Resolve coding denials through claim correction or appeal. Claim corrections will be made after review… more