- San Antonio Behavioral Health (San Antonio, TX)
- …documented in patient's medical records. + Reviews notices of potential denials and respond appropriately; ie facilitate Physician to Physician appeals ... when appropriate and assist with construction of appeal letters. + Tracks denial information for reporting to Quarterly UR Committee. + Maintains liaison with the Social Services department to facilitate timely discharge planning. + Enters complete and… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …+ Participate in Physician Psychologist Review Units' appeal process of service denials + Participate in development of Physician Psychologist Review Units' policies ... credentialed provider + Active clinical practice in order to participate in panel appeals + Experience in Utilization Management in a managed-care environment (as a… more
- Alameda Health System (San Leandro, CA)
- …roadmap, aligning with revenue cycle goals and regulatory compliance. + Analyze denials data (denial/remark codes) to identify trends, root causes, and areas for ... and payers to streamline data exchange and denial resolution through automated appeals , adjustments, and follow-ups. + Work with operations to establish key… more
- Cardinal Health (Sacramento, CA)
- …into the patients account in registration overlay. + Take any action necessary for any denials received by the payor to inform the clinician of changes that may need ... to happen to not delay patient care. + Complete any pre-service appeals to obtain paying approval based on medical necessity. + Communicate effectively with all… more
- KPH Healthcare Services, Inc. (Oklahoma City, OK)
- …complex or uncollectible accounts to management for further action. + Submit appeals /claim corrections as needed within timely filing limits. + Utilize billing ... as assigned. + Identify and report trends in claim denials and payment challenges. + Communicateasneededwithpatients about billing issues,including theresults… more
- Arkansas Children's (Little Rock, AR)
- …essential to performing job duties. Analyzes claims for payment. Resolves denials . Identifies problem trends and works to resolve. **Required Education:** High ... amount and to assure that unpaid amounts are valid and properly categorized. Appeals claims that are improperly adjudicated so they are promptly corrected. 4.… more
- South County Hospital (Wakefield, RI)
- …years' experience third party billing for physician services; Substantial experience with denials , edits and rejections; Extensive background in appeals and A/R ... collections; Significant experience with insurance carrier plans and carrier websites; Excellent analytical trending, and verbal/written communication required Minimum qualifications: + high school diploma or equivalent + two plus years of medical charge entry… more
- Swedish Health Services (Seattle, WA)
- **Description** Follow up on insurance denials and aged claims, submit claims to secondary payers, and ensure accurate billing information is submitted. Answer all ... government agencies, medical service bureaus, and insurance companies. Submit claims appeals with supporting documentation as necessary and resolve aged insurance… more
- UnityPoint Health (Cedar Rapids, IA)
- …clinical needs, barriers to quality care, effective utilization of resources and pursues denials of payment and referrals in a timely, legible manner. + Collects ... with thrird party payers regarding authorization of stay, continued stay reviews, appeals and denial letters. + Provides education and serves as a resource… more
- University of Rochester (Rochester, NY)
- …compliance, insurance company barriers and tracking all assistance provided. Plans, executes, appeals and follows through on all aspects of the process which has ... insurance company by applying knowledge and experience of previous authorization requests, denials , and approvals. On behalf of the provider and the University,… more