- Northwell Health (Melville, NY)
- …current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect patient's severity of illness ... Skills 3-5 years experience in Utilization Review, Case Management, and Clinical Appeals . 3-5 years of acute inpatient clinical experience. Experience with MCG… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …revenue cycle teams. The UM Analyst helps ensure regulatory compliance, timely appeals , and reduction of avoidable denials through proactive collaboration and ... years of experience in clinical care, utilization review, case management, or clinical denials / appeals -OR- * An approved equivalent combination of education and… more
- Hartford HealthCare (Farmington, CT)
- …review of medical records, coding, and clinical documentation to validate or appeal payer denials . . Prepare, document, and submit appeals for DRG denials , ... multiple denials , prioritize tasks, and ensure timely submission of appeals . . Experience with electronic health record (EHR) systems, coding software, and… more
- Houston Methodist (Houston, TX)
- …coding staff; and functions as clinical subject matter expert related to coding denials and appeals . **PEOPLE ESSENTIAL FUNCTIONS** + Communicates openly in a ... At Houston Methodist, the Coding Charges & Denials Specialist is responsible for coordinating and monitoring the coding-specific clinical charges and denial… more
- Beth Israel Lahey Health (Burlington, MA)
- …Billing Office. 15. Independently works on the resolution of complex claims issues, denials , and appeals . 16. Completes projects and research as assigned. 17. ... job, you're making a difference in people's lives.** The Denials Specialist 3 role specializes in high-dollar claims, aged...complex specialties. This role identifies and works to resolve denials to uncover the root cause and accurately appeal… more
- BronxCare Health System (Bronx, NY)
- Overview Assists in the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute ... action in order to improve outcomes. - Maintains an excel log related to denials / appeals activities in order to monitor successful appeals . - Assists with… more
- SSM Health (MO)
- …through process improvement. + Oversees communication and follow-up processes related to denials and appeals to ensure such activities are submitted timely, ... Coordinates with Health Information Management and Case Management leadership on con-current denials . Review denial data appeals and under payment issues and/or… more
- Molina Healthcare (Atlanta, GA)
- …subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** Responsible for reviewing and resolving... appeals and denials . + Strong verbal and written communication skills To… more
- Beth Israel Lahey Health (Plymouth, MA)
- …status of completion. + Reviews and determines appropriate strategy in response to reimbursement denials . + Responsible for appeals and follow up on clinical ... a difference in people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who We Are:** At **Beth Israel… more
- TEKsystems (Annapolis, MD)
- …prevention of clinical denials . This staff member reviews all initial clinical denials to determine next steps and conducts appeals as appropriate, such as ... clinical denial appeals specialist also works to prevent future clinical denials by communicating with clinical and revenue cycle leadership about denial root… more