- Beth Israel Lahey Health (Cambridge, MA)
- …skills to prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer review. ... & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality...knowledge of disease and nursing processes to write effective appeals and clinical abstracts, identifies quality of… more
- State of Colorado (Greeley, CO)
- Behavioral Health Specialist , Social Work / Counselor III - Platte Valley Youth Services Center Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5097665) Apply Behavioral Health Specialist , Social Work / Counselor III - Platte Valley Youth… more
- CaroMont Health (Gastonia, NC)
- …denial activity and appeal results. Maintains the Status Change Database. Performs retrospective clinical reviews/ appeals as part of denial process. The UR ... best utilization regarding level of patient care, diagnostic testing, and clinical procedures without jeopardizing patient quality efforts. Identifies and reports… more
- Robert Half Accountemps (Santa Barbara, CA)
- Description We are looking for a meticulous Medical Billing Specialist to join our team in Santa Barbara, California. This long-term contract position offers an ... excel in communication and collaboration, supporting both patients and clinical staff in navigating complex billing and authorization procedures. Responsibilities:… more
- Fairview Health Services (St. Paul, MN)
- …the development of denial reports and other statistical reports. + Collaborates with Clinical Denials Nurse Specialist and Leadership in high-dollar claim denial ... **Job Overview** The Inpatient Coding Denials Specialist performs appropriate efforts to ensure receipt of...records and coding guidelines to formulate coding arguments for appeals and/or coding guidance for potential re-bills. Maintains a… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending....TRAINING AND EXPERIENCE: + Minimum of 2-5 years of clinical nursing experience in an acute care hospital setting… more
- Guthrie (Sayre, PA)
- Position Summary: Fulfills all requirements of Insurance Specialist I, as well as serving as a group leader by participating in staffing and employment issues. ... Serves as a resource specialist within the department. Trains Insurance Billing Specialists I...to complete all types of complex insurance billings and appeals . Reviews and analyzes the insurance processing procedures to… more
- US Tech Solutions (May, OK)
- …with other internal groups regarding determination status and results (seniors, pharmacists, appeals , etc). + Identify and elevate clinical inquiries to the ... **Job Description:** The Rep I, Clinical Services takes in-bound calls from providers, pharmacies,...resolve coverage requests. Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. Must… more
- Insight Global (Pleasanton, CA)
- Job Description Insight Global is seeking a Medicare Billing Specialist to join their clients team. The Medicare Billing Specialist is responsible for the ... accounts and resolve payment discrepancies. * Identify underpayments and coordinate appeals or resubmissions. * Maintain current knowledge of CMS and Medicare… more
- Robert Half Accountemps (Duarte, CA)
- Description We are looking for an experienced Medical Biller/Collections Specialist to join our team in Duarte, California. The Medical Biller/Collections ... Specialist will play a vital role in managing the...measures to reduce future denials. * Draft and submit appeals for claim denials to secure appropriate reimbursements. *… more