• Denials Specialist 2 / HIM Coding

    Hartford HealthCare (Farmington, CT)
    …of medical records, coding, and clinical documentation to validate or appeal payer denials . . Prepare, document, and submit appeals for DRG denials , ... validation denials . This role involves validating the coding and clinical accuracy, ensuring proper documentation, and collaborating with other departments to… more
    Hartford HealthCare (07/01/25)
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  • Clinical Denial Appeals Specialist

    TEKsystems (Annapolis, MD)
    … clinical denials . This staff member reviews all initial clinical denials to determine next steps and conducts appeals as appropriate, such as by ... The clinical denial appeals specialist also works to prevent future clinical denials by communicating with clinical and revenue cycle leadership… more
    TEKsystems (08/26/25)
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  • Manager - Utilization Review…

    Beth Israel Lahey Health (Plymouth, MA)
    … denials . + Responsible for appeals and follow up on clinical denials escalated through a work queue, providing appropriate response supported by ... people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who...UR and the analysis, resolution, monitoring & reporting of clinical denials . + Maintains current knowledge of… more
    Beth Israel Lahey Health (07/29/25)
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  • Coding Appeals Specialist

    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
    St. Luke's University Health Network (08/18/25)
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  • Clinical Reimbursement Case Management…

    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 ... while making a meaningful impact in the communities we serve. Responsibilities The Manager , Case Management is responsible for the clinical , administrative, and… more
    Genesis Healthcare (07/01/25)
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  • Clinical Authorization Specialist

    Dana-Farber Cancer Institute (Brookline, MA)
    …high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and ... Clinical Authorization Specialist is also responsible for managing denials related to front-end prior authorization, biosimilar drugs, pharmacy-benefit exclusion… more
    Dana-Farber Cancer Institute (08/20/25)
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  • Clinical Case Manager

    LifePoint Health (Rutherfordton, NC)
    …payer guidelines and financial implications of discharge plans.5. Follows up with any denials through the appeals process; including RAC chart audit reviews. ... **Please select a valid job field* **Organization:** ** **Title:** * Clinical Case Manager * **Location:** *NC-Rutherfordton* **Requisition ID:** *7462-9861* more
    LifePoint Health (08/09/25)
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  • Clinical Resource Manager Part-Time…

    Trinity Health (Nampa, ID)
    …and the highest quality of care. We are looking to hire a ** Clinical Resource Manager ** for our Medical Center in Nampa, Idaho ... that can't be beat. **About this position:** As a Clinical Resource Manager you will provide concurrent...by third party payers and Medicaid. + Responsible for appeals , denials , as appropriate. Utilizes physician advisor… more
    Trinity Health (08/08/25)
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  • High Risk Nurse Care Manager

    Children's Mercy Kansas City (Kansas City, MO)
    …Nurse Lead manages high risk administrative processes and data related to medical necessity denials , clinical appeals , long length of stay rounds, and ... tools and tracking to monitor status and outcomes of denials and appeals to identify trends and...Nurse Lead is an expert at the roles of Clinical Review Nurse Care Manager and Care… more
    Children's Mercy Kansas City (06/18/25)
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  • Delivery Senior Manager

    NTT America, Inc. (Plano, TX)
    … to join our team. NTT DATA is seeking to hire a **Medicare Appeals Clinical Leader** to lead service delivery engagements and improve end-to-end delivery ... of Medicare Appeals . Desire experience specifically for processes for clinical appeals coordinators but this role will be a leader in the end-to-end delivery… more
    NTT America, Inc. (06/12/25)
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