- Highmark Health (Harrisburg, PA)
- …AHN departments/Teams in denial prevention activities. **ESSENTIAL RESPONSIBILITIES** + Reviews clinical denials , audits and accounts as assigned.Composes and ... Health Network **Job Description :** **GENERAL OVERVIEW:** Responsible for all aspects of clinical appeal activities to include but not limited to, clinical … more
- Beth Israel Lahey Health (Plymouth, MA)
- … denials . + Responsible for appeals and follow up on clinical denials escalated through a work queue, providing appropriate response supported by ... UR and the analysis, resolution, monitoring & reporting of clinical denials . + Maintains current knowledge of... clinical information. + Provides oversight of the … more
- BronxCare Health System (Bronx, NY)
- …by the department physician advisors and clinical staff. Qualifications - NYS Registered Nurse required - The Appeal Manager must have excellent verbal and ... arrive in letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal… more
- Community Health Systems (Franklin, TN)
- …the denial and appeal status. + Consults with Coordinator and/or Director, Coding Denials and Appeals during any audit discrepancies. + Attends coding education ... quality monitoring and evaluation of work products by the Coordinator and/or Director, Coding Denials and Appeals . + Partners with peers and Director to develop… more
- University of Michigan (Ann Arbor, MI)
- Utilization Rev Appeals Spec Apply Now **Job Summary** **Why Join Michigan Medicine's Hospital Billing Audits & Appeals (HBAA) Department?** The Audit and ... knowledgeable about insurance requirements and medical billing practices. The Appeals Specialist will collaborate with multiple departments to maintain compliance… more
- Mount Sinai Health System (New York, NY)
- …timely and appropriate communication with payers for authorization, denials , and appeals . + Collaborate with physicians and clinical teams to ensure ... (CCM, ACM) or Utilization Management preferred. + 7+ years of experience in clinical acute clinical , utilization management, appeals management or related… more
- Crouse Hospital (Syracuse, NY)
- …requirements and contractual agreements. Care Coordination Manager Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree + Five ... responsible for providing day to day management of the RN Care Managers in the department. Pay Range: $95,000...in the department, including Utilization Management, Discharge Planning and Denials and Appeals functions. + Assessing workflow… more
- Hartford HealthCare (Farmington, CT)
- …management and appeals preferred. **Licensure, Certification, Registration** * Active Registered Nurse license from the State of Connecticut * Certified ... of medical records, coding and clinical documentation to validate or appeal payer denials . . Prepare, document and submit appeals for DRG denials ,… more
- HCA Healthcare (Nashville, TN)
- …, denials , managed care contracting, experienced preferred. + Currently licensed as a registered nurse ( RN ) in the state(s) of practice and/or has an ... to join an organization that invests in you as an Inpatient Authorization Review Services Registered Nurse or Licensed Practical Nurse -NICU (Code Pink)? At… more
- Nuvance Health (Danbury, CT)
- …or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience in an acute care setting * ... strategic leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while… more