- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data ... needed for workflow or identification of trends. Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and… more
- Penn Medicine (Bala Cynwyd, PA)
- …provider groups and alternative care settings. Under the direction of the Director of Hospital Compliance, Government Audit and Appeals , receives, reviews, ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
- Humana (Harrisburg, PA)
- …_Outcomes_ : Characterize the impactable drivers of prior authorization and look at appeals rate with denials and overturns. Deliver the upmost consistent ... are seeking an accomplished healthcare physician leader for the newly-created role of Director , Physician Leadership. In this role, you will be a key enterprise… more
- UPMC (Pittsburgh, PA)
- The Regional Medical Director , CC/DP and Utilization Review, provides clinical and management leadership across multiple hospitals within the region. This role ... and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice President of Care...denials . + Direct UM functions, collaborating with CC/DP, clinical teams, and attending physicians to optimize care delivery… more
- Genesis Healthcare (York, PA)
- …to reduce AR/DSO and outstanding clinical accounts as needed and generates clinical appeals when necessary. 15. Assists with and completes special projects ... assure systems in place to interface with financial and clinical outcomes. 4. In collaboration with the Director...a formal procedure for effectively addressing concurrent and retrospective clinical and administrative denials by payors and… 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
- Guthrie (Troy, PA)
- …other hospital departments as appropriate to track and monitor the status for denials and appeals . + Participates in performance improvement and educational ... associated with UM processes and operations. Experience Minimum of five years clinical experience in an acute health care setting. Must possess strong communication… more
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