- Trinity Health (Nampa, ID)
- …needed and requested by third party payers and Medicaid. + Responsible for appeals , denials , as appropriate. Utilizes physician advisor referral as appropriate. ... care. We are looking to hire a **Clinical Resource Manager ** for our Medical Center in Nampa, Idaho (http://https://www.saintalphonsus.org/location/saint-alphonsus-medical-center-nampa-1)… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …and champion successful relationships with Care Coordination (Utilization Management, Denials Management, and Progression/Transition of Care) * Establish partnership ... resources to achieve optimal outcomes * Notify the case manager of any conflict of interest in reviewing a...(LOS) ○ Assist with the identification and management of denials ○ Make suggestions related to resource utilization and… 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
- University of Southern California (Arcadia, CA)
- …mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials , and appeals . + Collaborates and communicates with multidisciplinary team ... maintain BLS certification. Preferred (Not required) Professional certification as a case manager preferred. Pay Transparency The hourly rate range for this position… more
- Sharp HealthCare (San Diego, CA)
- …care, SNF, home health, or hospice settings. + Experience as a case manager or discharge planner interacting with managed care payers. + Experience with InterQual ... stay beginning with the admission review of the case manager and reviews with the Case Manager ...accurately follows Health Plan and/or Medicare Guidelines when issuing denials .Ensures that all denials for medical necessity… more
- Mount Sinai Health System (New York, NY)
- …data entry of codes. + Posts all payments in IDX. Runs and works missing charges, edits, denials list and processes appeals . Posts denials in IDX on a timely ... collection. The Specialist works directly with the Department Administrator. Reports to Billing Manager /Revenue Cycle Manager . *Please note that this is NOT a… more
- Hartford HealthCare (Farmington, CT)
- …Responsible for the timely realization of payment for active inventory, resolution of denials , overseeing the effective appeals of these claims and protecting ... resources, vendors, and client relations. This position reports directly to the Manager of Patient Financial Services Accounts Receivables and works closely with… more
- Guthrie (Sayre, PA)
- …Insurance Billing Specialists I and related support staff. Works closely with Director, Manager , Supervisor and Application Analyst on day to day priorities and to ... necessary action to complete all types of complex insurance billings and appeals . Reviews and analyzes the insurance processing procedures to identify potential… more
- Trinity Health (Fort Wayne, IN)
- …to benefits investigation, prior authorization request and submission, overturning appeals , and enrolling patient in financial assistance programs. Manages the ... each contact made to the patient, provider, and insurance plan. Facilitates appeals process between the patient, physician, and insurance company by requesting… more
- WMCHealth (Valhalla, NY)
- …role is expected. Does related work as required. Responsibilities: + Addresses appeals to insurance denials to facilitate expedient resolution and reimbursement. ... Job Details: Job Summary: The Senior Inpatient Coder is responsible for addressing appeals to insurance companies and coding highly complex medical records using the… more