- Centene Corporation (Jefferson City, MO)
- …and other ad hoc committees. + May oversee all aspects of the Appeals and Denials department including implementing budgetary, policy, and personnel decisions ... medical directors and supervise MD's responsible for utilization management and appeals functions to ensure members receive medically necessary, evidence-based care… more
- Nuvance Health (Danbury, CT)
- …leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical support staff while partnering with ... will be responsible for leading a team encompassing utilization review and denials / appeals specialists and will need to foster a culture of collaboration,… 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
- Guthrie (Sayre, PA)
- …and Audit Manager is responsible for the oversight and management of all payer denials , appeals , and audit processes within the health system. This role ensures ... with responsibility and management of billing and reimbursement. Essential Functions Denials & Appeals Management + Oversee daily operations of the denials … more
- Covenant Health Inc. (Knoxville, TN)
- …Business Office personnel to resolve issues related to claims, coding, pre-cert, and denials appeals , and verifies that appropriate chargemaster rates are used. ... and hospital personnel to ensure qualifying diagnosis covers tests/procedures. + Analyzes denials and coordinates appeals . + Ensures corrective action is taken… more
- St. Bernard's Medical Center (Jonesboro, AR)
- …departments to discuss trends, opportunities, etc. Assists Revenue Integrity Coordinator with denials appeals . Close out each tracked denial (overturned or ... 2 - 5 years of healthcare experience preferably with knowledge of the reimbursement/ denials process. Should have knowledge of ICD 10 & CPT coding and guidelines.… more
- Community Health Systems (Antioch, TN)
- …in Artiva, HMS, Hyland, BARRT, and other host systems, ensuring timely follow-up on denials and appeals . + Conducts follow-up calls and payer portal research to ... for reviewing, tracking, and resolving denied claims, ensuring that appropriate appeals are submitted, and working closely with payers, internal departments, and… more
- Brockton Hospital (Brockton, MA)
- …external review agencies, to coordinate activities involved in medical record review, denials , appeals and reconsideration hearings. Works closely with the ... ensure compliance with Signature Healthcare Hospital standards, prompt notification of denials , questionable cases and cases referred for outside review. Monitors… more
- Community Health Systems (Franklin, TN)
- …ensures efficient and effective management of utilization review processes, including denials and appeals activities. This role collaborates with payers, ... process improvement initiatives, and serves as a key liaison to reduce denials and optimize patient outcomes. **Essential Functions** + Submits initial assessments,… more
- St. Luke's Health System (Boise, ID)
- …Collaborates with insurance carrier appeal teams and clinical teams to resolve denials and appeals efficiently, and coordinates peer-to-peer reviews. + ... clinical teams, insurance companies and Patient Financial Navigators to address insurance denials and manage appeals . + Educates patients on insurance benefits,… more
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