- Beth Israel Lahey Health (Plymouth, MA)
- …concurrent and retrospective reviews for level of care and continued stay * Lead appeals of clinical denials and collaborate with physician advisors * ... - Utilization Review & Denials Management** This role is ideal for a Manager with strong clinical knowledge, leadership skills, and a passion for innovation… more
- Stony Brook University (Stony Brook, NY)
- Case Manager - Per Diem **Position Summary** At Stony...the hospital stay. + Assist with coverage for UR, Appeals and denials + Actively involved in ... Brook Medicine, a **Case Manager ** is a valuable member of our team, who...is a valuable member of our team, who provides clinical services to our patient population. Qualified candidates will… more
- Houston Methodist (Houston, TX)
- …verbal and written communication. + Identifies denial trends and notifies supervisor and/or manager to prevent future denials and further delay in payments. ... services. This position performs collections activities on simple and complex denials and on outstanding insurance balances in the professional fee environment.… 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
- Sharp HealthCare (San Diego, CA)
- …with providers.Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials , input into appeals , share findings with providers.Review all cases ... **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered… more
- UNC Health Care (Chapel Hill, NC)
- …+ Protects hospital revenue by working with payors for insurance authorizations, denials , and appeals + Delivers mandated federal notices to patients/ ... through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff… more
- Highmark Health (Monroeville, PA)
- …all regulatory and contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials / appeals and retrospective payer audit ... lieu of a degree + 3 years in a clinical nursing role + Current State of PA RN...**Required** + None **Preferred** + ACM Certification (Accredited Case Manager ) - American Case Management Association - American Case… more
- Rochester Regional Health (Rochester, NY)
- …RESPONSIBILITIES: + Review standard UM sources for potential inpatient medical necessity denials . Review patient class in the event manager , assist with ... or no appeal is necessary per UM reviews. + Track and monitor all denials , appeals , arbitration responses to payers/audits. + Participates in periodic denial… more
- Amgen (New York, NY)
- …supporting the entire reimbursement journey through payer prior authorization to appeals / denials requirements and forms + Review patient-specific information in ... lives of patients while transforming your career. **Field Reimbursement Manager - New York** **What you will do** Let's...third-party access arena or pharmaceutical industry in managed care, clinical support, and/or sales OR Master's degree AND 6… 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 ... collaboration, analysis, process mapping and education with support area providers, clinical and operations leadership, and revenue cycle subgroups. This position… more
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