- US Tech Solutions (San Antonio, TX)
- …criteria for prospective and concurrent reviews of cases. authorizations. **Duties** 1 . Collaborates with the CRU Technician to process referrals, including ... patient and other healthcare professionals following agreed upon approval & denial management processes. (15%) 3. Handles inbound phone calls and escalations… more
- Trinity Health (Hartford, CT)
- …continual basis with the Collections Manager + Review EOB denials and identifies denial trends along with solutions for resolution + Run accounts receivable aging ... + Full time 40hrs M-F days + Excellent benefits - starting day 1 ! **Ministry/Facility Information** Saint Francis Hospital is committed to exceeding the expectations… more
- Nuvance Health (Danbury, CT)
- …Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician Advisors ... within the department. Serves as front line liaison for department. *Responsibilities:* 1 . Assist with tracking and compiling data for performance metrics and audit… more
- Sharp HealthCare (San Diego, CA)
- …Offices **City** San Diego **Department** **Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Bachelor's Degree **Hours** **:** ... **Essential Functions** + Account AuditAudit open and closed balance accounts for denial , underpay, and no pay reasons, and successfully collect additional monies… more
- MyFlorida (Tallahassee, FL)
- 857093 - OPS EMPLOYMENT SECURITY REP II - 40099084 1 1 1 1 1 1 Date: Oct 16, 2025 The State Personnel System is an E-Verify employer. For more ... 857093 - OPS EMPLOYMENT SECURITY REP II - 40099084 1 1 1 1...of work, ability and availability for work, "between terms denial " relating to individuals employed by educational institutions, self-employment,… more
- Idaho Division of Human Resources (Twin Falls, ID)
- Child Welfare Social Worker 1 or 2 - CYFS Posting Begin Date: 2025/10/17 Posting End Date: 2025/11/16 Category: Human Services Work Type: Full Time Location: Twin ... team located at our Twin Falls field office as a Child Welfare Social Worker 1 (licensed social worker in Idaho) or Child Welfare Social Worker 2 (licensed social… more
- Molina Healthcare (Albuquerque, NM)
- …details in the database. * Provides supporting documentation management for denial and modification of payment decisions. * Independently re-evaluates medical claims ... clinical guidelines and other appropriate criteria with medical directors on denial decisions. * Supplies criteria supporting all recommendations for denial… more
- Tufts Medicine (Lowell, MA)
- …issues, to ensure proper coding and reimbursement. Works with leadership to review denial and reimbursement reports for accuracy, as well as conducting audits to ... Hospital** **Location: Lowell General Hospital - Main Campus** **Minimum Qualifications** **:** 1 . High school diploma or equivalent. 2. Completion of medical coding… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …when appropriate * Collaborates with department director and professional development specialist to develop standard work and expectations for the utilization review ... and monitor to identify opportunities to improve processes for denial prevention * Serves as the internal expert on...(5) years clinical experience * A minimum of one ( 1 ) year of utilization review experience */Preferred Qualifications:/* *… more
- LA Care Health Plan (Los Angeles, CA)
- …Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the ... duties as assigned. Duties Functional Elements: Technical Support to UM Specialist : Processing of time sensitive authorization and pre-certification requests to meet… more