- UNC Health Care (Goldsboro, NC)
- …and conduct of administrative and/or judicial, local and up to State appeals . 7. Gathers and provides necessary verification to establish Medicaid eligibility via ... findings, evaluates and Represents the patient(s) if challenges presents including Denials and Unsatisfied approvals/decisions from the local Counties Department of… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …appropriate + Participate in the PRU's appeal process of service and claims denials + Participate in the development of PRU's policies and procedures + Actively ... the state of Massachusetts + Active clinical practice in order to process appeals + Experience in Utilization Management in a managed-care or risk contract… more
- Community Wellness Partners (Oswego, NY)
- …Nursing services and provide. complete team with documentation information to prevent payment denials . 8. Utilizes the RAI, MDS 3.0, QM and QRP manuals to ensure ... (demand bill) 19. Issues NOMNC to residents/responsible party and assists with the appeals process, as needed. 20. Completes QA audits as assigned 21. Recognizes… more
- Huron Consulting Group (Chicago, IL)
- …variety of activities involving the coding of medical records, resolving coding related denials , and auditing of coders to ensure coding accuracy standards are met. ... (eg, Inpatient, E&M, Ambulatory, Surgery, Cardiology, Radiology), including denial review and appeals . + 2+ years of experience as a coding auditor with proven… more
- Dartmouth Health (Bennington, VT)
- …accordance with departmental and organizational policies and procedures. Manages technical denials process including, but not limited to, contacting third party ... carriers, writing appeals , etc. Serves as an ambassador for departmental initiatives, including but not limited to, assessing and implementing staff training,… more
- Catholic Health Initiatives (Omaha, NE)
- …collect outstanding balances from third-party payers. Every day you will review denials , initiate follow-up with insurers, rectify billing errors, submit appeals ... , and negotiate for maximum reimbursement. To be successful, you will understand billing regulations, possess strong problem-solving skills, and communicate effectively to optimize revenue recovery. + Follows-up with insurance payers to research and resolve… more
- Robert Half Accountemps (Dallas, TX)
- …unpaid claims starting from the 45th workday after the date of service. * Submit appeals using approved templates and forward medical or coding denials to the QA ... Department for review. * Facilitate secondary insurance filings and ensure explanations of benefits are properly documented. * Establish payment arrangements with patients, adhering to timelines and policies. * Conduct skip tracing for accounts requiring… more
- Bozeman Health (Bozeman, MT)
- …the claims denial process for insurance carriers and develops an appropriate appeals response as necessary. Minimum Qualifications: Required + High School diploma ... and referring clinics regarding pre-authorizations. + Collaborates with staff regarding denials . + Reviews patient assistant program guidelines for potential patient… more
- Robert Half Office Team (Blue Ash, OH)
- …Track authorization statuses and promptly notify healthcare teams regarding approvals, denials , or pending requests. * Stay informed about current insurance policies ... patterns of denied authorizations and collaborate with teams to handle appeals , escalations, or resubmissions. * Maintain organized records and detailed reports… more
- FlexStaff (New York, NY)
- …this role you will be ensuring timely and accurate claims processing, managing denials , and assisting with billing-related reporting and audits. This is a full-time, ... commercial plans. * Investigate and resolve denied or unpaid claims, handling appeals , resubmissions, and necessary corrections. * Analyze denial trends and offer… more