- Northwell Health (Melville, NY)
- …and the third party payer. Prepares and defends level of care and medical necessity for assigned case. Collaborates with physician advisor, payor representative and ... regulations. Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal… more
- Hartford HealthCare (Farmington, CT)
- …**Job:** **Coding and Billing* **Organization:** **Hartford HealthCare Corp.* **Title:** * Denials Specialist 2 / HIM Coding* **Location:** ... of medical records, coding, and clinical documentation to validate or appeal payer denials . . Prepare, document, and submit appeals for DRG denials ,… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical ... to make appropriate decisions and is accountable for reviewing denials for level of care, medical necessity,...and denials for no authorization. The Senior Denials Management Specialist position communicates clinical information… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Coding Charges & Denials Specialist is responsible for coordinating and monitoring the coding-specific clinical charges and denial ... functions as clinical subject matter expert related to coding denials and appeals . **PEOPLE ESSENTIAL FUNCTIONS** +...various sources ( medical records, claims data, payer medical policies, etc.), determines the causes for denials… more
- St. Luke's University Health Network (Allentown, PA)
- … Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks outcomes regarding appeal process. Assists ... Reviews all Inpatient Retroactive Denials in the Denials Management Work Queues for Medical Necessity... and rejections. + Assists in preparing reports regarding denials to include volumes, number of appeals ,… more
- HCA Healthcare (El Paso, TX)
- …and federal agencies and accrediting bodies. The Inpatient Coding Denials Specialist must ensure timely, accurate, and thorough appeals for all accounts ... organization that invests in you as an Inpatient Coding Denials Specialist ? At Parallon, you come first....colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no… more
- Beth Israel Lahey Health (Burlington, MA)
- …not just taking a job, you're making a difference in people's lives.** The Denials Specialist 3 role specializes in high-dollar claims, aged claims, and denied ... accurately appeal claims to ensure successful initial submission. The Denials Specialist 3 will be responsible for...Independently works on the resolution of complex claims issues, denials , and appeals . 16. Completes projects and… more
- TEKsystems (Annapolis, MD)
- …concerns, and/or reconciling coverage-related issues. The clinical denial appeals specialist also works to prevent future clinical denials by communicating ... Description Position Summary The clinical denial appeals specialist is responsible for the... denials to determine next steps and conducts appeals as appropriate, such as by reviewing medical… more
- HCA Healthcare (Brentwood, TN)
- …Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Clinical Denials Coding Review Specialist with Parallon you can be a part ... you need to succeed in our organization. We are looking for an enthusiastic Clinical Denials Coding Review Specialist to help us reach our goals. Unlock your… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …the general supervision of the Director of Patient Financial Services, the Clinical Appeals Specialist performs advanced level work related to clinical denial ... management. The individual is responsible for managing medical denials by conducting a comprehensive review...a comprehensive review of relevant clinical documentation. The Clinical Appeals Specialist will write compelling arguments based… more