- University of Southern California (Alhambra, CA)
- …and electronic claims; process tracers, denial and related correspondence; initiate appeals ; compose and submit appeal letters specific challengeable denial issues ... Provides feedback and guidance to office staff regarding coding, claim appeals , authorizations and diagnosis requirements. + Contacts government and third-party… more
- Prime Healthcare (Philadelphia, PA)
- …Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review ... insurance providers and health plans regarding authorization, expedited reviews and appeals . Document and track all communication attempts with insurance providers… more
- Prime Healthcare (Chino, CA)
- …Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review ... insurance providers and health plans regarding authorization, expedited reviews and appeals . Document and track all communication attempts with insurance providers… more
- Carle Health (Champaign, IL)
- …Responsible for handling escalated account and payer disputes. Handles complex edits, appeals and advanced account activities such as settlement and refund requests, ... management, estate claims, fraud cases and attorney requests, etc. Handles escalated appeals . Identifies payer and system issues to initiate project requests for… more
- HCA Healthcare (Tallahassee, FL)
- …issues and to make notes regarding payment.** 1. **Reviews daily preservice log, appeals inventory, and write-offs on a daily basis, reports back to billing ... team on follow up and resolution of coding related denials and rejections.** 1. **Supervises front office staff on...1. **Works E-request for PAS for medical records for appeals , and missing information needed to get claims paid.**… more
- Insight Global (Pleasanton, CA)
- …accounts and resolve payment discrepancies. * Identify underpayments and coordinate appeals or resubmissions. * Maintain current knowledge of CMS and Medicare ... billed services. * Audit claims to minimize risk of denials or audits. * Investigate and resolve denied or...Investigate and resolve denied or rejected claims. * Prepare appeals with supporting documentation as needed. * Track denial… more
- CommonSpirit Health (Phoenix, AZ)
- …an integrated system-wide utilization management program which includes comprehensive denials management. This role is critical to maintaining the organization's ... and serve as the clinical authority on complex cases, appeals , and exceptions, ensuring decisions are made based on...years of experience performing government, managed care, and commercial appeals required. + Minimum 7 years of experience in… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- …to billing and supporting documentation, as well as facilitates the completion of appeals in a timely manner. + Prepares trend and other reports for compliance ... to hospital departments regarding compliance with billing regulations and trends in denials of services due to medical necessity or appropriateness of services. +… more
- CaroMont Health (Gastonia, NC)
- …Management and Senior management as necessary. Retrospectively reviews medical record for clinical denials . Composes a detailed summary of care and sends appeals ... and appeal results. Maintains the Status Change Database. Performs retrospective clinical reviews/ appeals as part of denial process. The UR Specialist will be cross… more
- MyFlorida (Largo, FL)
- …as instructed. + Work directly with all payors on all resident reimbursement denials and file inquiries, reconsiderations, refunds and appeals to the appropriate ... agency or individual(s) for rejected claims. + Perform other duties as directed in an efficient, professional, and timely manner. This position is in the Career Service System. The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer,… more