- Mount Sinai Health System (New York, NY)
- …facilitates and tracks concurrent adverse determinations and collaborates with Appeals Management Department in managing retrospective denials . ... **Job Description** **Utilization Management Specialist MSH Case Management FT Days** This position...Days** This position is responsible for coordinating requests for clinical information from third party payers and providing support… more
- UCLA Health (Los Angeles, CA)
- …statuses, tracking cases and maintaining updated records in various systems + Review claim denials for clinical issues, prepare appeals , and manage each ... and quality in claim processing. As an Audit and Appeals Specialist , you will: + Facilitate responses...knowledgeable, detail-oriented professional with: + Bachelor's degree in a clinical or related field, or equivalent training and experience… 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
- CaroMont Health (Gastonia, NC)
- …Care Management and Senior management as necessary. Retrospectively reviews medical record for clinical denials . Composes a detailed summary of care and sends ... appeal results. Maintains the Status Change Database. Performs retrospective clinical reviews/ appeals as part of denial process....appeals as part of denial process. The UR Specialist will be cross trained to work for the… more
- BriteLife Recovery (Englewood, NJ)
- …clinical information and advocating for appropriate levels of care. The UR Specialist works closely with clinical staff, admissions, medical providers, and ... What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible for… more
- University of Virginia (Charlottesville, VA)
- …assigned AR responsibility. + Performs inpatient/outpatient follow up and working insurance denials , appeals claims as defined by payer and departmental rules. ... The Central Billing Office (CBO) Insurance Resolution Specialist handles and resolves all Insurance billing follow up and denial issues to ensure all facilities… more
- University of Utah Health (Salt Lake City, UT)
- …claims, ensuring timely and appropriate reimbursement based on contract terms. + Resolves denials through CARC analysis and appeals . + Acts as patient advocate ... EO/AA_ This position is responsible for insurance receivables collections, denials resolution and internal/external customer service. Account portfolio may include… more
- Garnet Health (Middletown, NY)
- …responsible for the day to day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate processes, ... to make your career home with us as a CLinical Documnetaion Specialist on our CDI team... Documentation Improvement and Patient Access, the Manager of Clinical Documentation Integrity (CDI) and DRG Denials … more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …coding staff on documentation and coding guidelines. + Reviewing medical coding claim denials for correction and appeals within the AthenaIDX and Enterprise Task ... **43114BR** **Extended Job Title:** Coding Specialist **Org Level 1:** Texas Tech Unv Hlth...and assisting the external medical coding vendor by clarifying clinical documentation or coding questions. This includes providing feedback… more
- Aligned Modern Health (IL)
- …resubmit claims to payers. + Review unpaid and/or denied claims and submit appeals . + Follow-up with insurance companies, addressing denials and rejections, etc. ... disorders, infertility, musculoskeletal pain, and more. We pride ourselves on outstanding clinical outcomes and a five-star patient experience. We have 16 clinics… more