- Hartford HealthCare (Farmington, CT)
- …of medical records, coding, and clinical documentation to validate or appeal payer denials . . Prepare, document, and submit appeals for DRG denials , ... validation denials . This role involves validating the coding and clinical accuracy, ensuring proper documentation, and collaborating with other departments to… 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 ... people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who...UR and the analysis, resolution, monitoring & reporting of clinical denials . + Maintains current knowledge of… more
- UTMB Health (Galveston, TX)
- …Operations (RCO) including team leads and specialists ( denials /follow-up). The Manager interacts with UTMB leadership, including clinical and finance. ... Manager , Hospital/Professional Insurance Follow-Up - Revenue Cycle HB...Responsible for timely and accurate account resolution, including payer appeals for all denials and underpayments. +… more
- BronxCare Health System (Bronx, NY)
- …best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and trending of all denials ... and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible...to assist the department attain its objective of managing denials and appeals . Responsibilities - Types, utilizing… more
- St. Luke's University Health Network (Allentown, PA)
- …to, physicians, hospital employees and vendors. Advises Network CDI & DRG Denials Manager on issues requiring immediate attention. ADDITIONAL REQUIREMENTS: ... regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding of… more
- Elevance Health (Irving, TX)
- …additional information if necessary. + Ability to initiate pre-determination, prior authorizations, and appeals for denials based on payer policy. + Ability to ... home setting._ **Referral Specialist II/Patient Access (Pre & Prior Authorizations, Appeals , Insurance) - Paragon Infusion** **Location:** 3033 W President George… more
- Hartford HealthCare (Farmington, CT)
- …(HIM) Clinical Documentation Integrity (CDI) quality, audit, education, and denials prevention program consistent with clinical , regulatory, contractual, and ... Hospital Acquired Conditions (HACs), and other specialty reviews. This position also supports denials and appeals specialists as a subject matter expert (SME)… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and ... Clinical Authorization Specialist is also responsible for managing denials related to front-end prior authorization, biosimilar drugs, pharmacy-benefit exclusion… more
- Genesis Healthcare (York, PA)
- …to reduce AR/DSO and outstanding clinical accounts as needed and generates clinical appeals when necessary. 15. Assists with and completes special projects ... while making a meaningful impact in the communities we serve. Responsibilities The Manager , Case Management is responsible for the clinical , administrative, and… more
- LifePoint Health (Rutherfordton, NC)
- …payer guidelines and financial implications of discharge plans.5. Follows up with any denials through the appeals process; including RAC chart audit reviews. ... **Please select a valid job field* **Organization:** ** **Title:** * Clinical Case Manager * **Location:** *NC-Rutherfordton* **Requisition ID:** *7462-9861* more
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