- CommonSpirit Health (Centennial, CO)
- …you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care sites ... external third-party payers to appeal denied claims and retrospectively identifies appeals determination as indicated through research and coordination of completion… more
- Health Care Service Corporation (Tulsa, OK)
- …Is Responsible For Processing And Adjudicating Complex Non-Utilization. Management Appeals According To The Appropriate Federal, State, And Ncqa Requirements ... In Writing, To All Inquiries Involving Member*S Requests For Appeals . May Train And Mentor Less Experienced Appeals...customer service role OR in a health insurance or medical environment. * Knowledge of medical terminology… more
- Robert Half Legal (Mountlake Terrace, WA)
- …Robert Half is partnering with a Healthcare Organization searching for their next appeals specialist . This is an excellent opportunity for a motivated ... position is $21-$23/hr. Benefits available to contract/temporary professionals, include medical , vision, dental, and life and disability insurance. Hired… more
- Nuvance Health (Danbury, CT)
- …with CMS requirements, guidelines, and standardized published criteria to support the medical necessity of patient admission and continued hospital stays. This role ... payers. * If concurrent inpatient case does not meet medical necessity review criteria during the first level review,...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- Molina Healthcare (Salt Lake City, UT)
- …* Serves as a clinical resource for utilization management, chief medical officer, physicians, and member/provider inquiries/ appeals . * Provides training, ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal ...proficiency. **Preferred Qualifications** * Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager… more
- Nuvance Health (Danbury, CT)
- …*Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician Advisors (PAs) and other stakeholders ... in liaising with all above parties to submit provider appeals to insurance companies including Medicare and Medicaid for...Assists in timely sorting and dissemination of requests for medical information from insurers and other sources to the… more
- Ochsner Health (New Orleans, LA)
- …make a difference at Ochsner Health and discover your future today!** The Appeals Specialist is responsible for managing and resolving insurance claim denials ... underpayments to ensure accurate reimbursement. This role involves reviewing medical documentation, interpreting payer policies, and preparing detailed appeal… more
- Stanford Health Care (Palo Alto, CA)
- …excellent analytical and communication skills. The Clinical Government Audit Analyst and Appeals Specialist II will collaborate with clinical staff, coding ... Health Care job.** **A Brief Overview** Clinical Government Audit Analyst and Appeal Specialist II plays a critical role in the Revenue Cycle Denials Management… more
- Hartford HealthCare (Farmington, CT)
- …other common practices across the system.*__* *_Position Summary:_* The Denial Specialist 2 is responsible for reviewing, analyzing, and appealing denials related ... Key responsibilities include timely investigation of DRG downgrades, submitting appeals , coordinating follow-up actions, and ensuring compliance with regulatory… more
- Houston Methodist (Houston, TX)
- …items that result in resolution. Engages the coding follow up team for any medical necessity or coding related appeals . + Assures accounts are completed and ... At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect...perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the professional fee… more