- Stanford Health Care (Palo Alto, CA)
- …in the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials . This position ... with Management: Identify and escalate denial patterns to the Manager of Government Audits and Appeals , providing...regulations, payor policies, and industry best practices related to clinical appeals and denials management.… more
- MVP Health Care (Rochester, NY)
- …Monitor service utilization to maintain cost-effectiveness and manage Medical Loss Ratio (MLR). Appeals & Denials : Participate in the appeals process for ... improvement. To achieve this, we're looking for a Case Manager , Medicaid Long Term Support Program to join #TeamMVP....months after hire. At least 3 years of recent clinical and Case Management experience. Experience working in a… more
- Sun Pharmaceuticals, Inc (Syracuse, NY)
- …expertise in access and reimbursement issues encompassing coverage, prior authorizations, appeals , exceptions, denials , coding and payer payment guidelines , ... The Field Reimbursement Manager is part of the Market Access group...and quality programs related to value based care and clinical care pathways. **Responsibilities include:** + Incorporate knowledge of… more
- Jobleads-US (Chicago, IL)
- …contractual or administrative write-off and provide appropriate justification and documentation. Denials and appeals follow-up including root cause analysis to ... issues; communicates findings to patients. Coordinates the pre-certification process with the clinical staff as it relates to procedures in the Bronchoscopy Suite… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …In this role, you will be responsible for evaluating and responding to clinical and administrative denials referred to Case Management Department for appeal. ... Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of… more
- Alameda Health System (San Leandro, CA)
- SLH Case Manager RN + San Leandro, CA + San Leandro Hospital + SLH Social Services + Part Time - Day + Care Management + $58.74 - $97.91 per hour + Req #:42605-31625 ... + FTE:0.7 + Posted:August 6, 2025 **Summary** **JOB SUMMARY** The SLH Case Manager RN is responsible for providing comprehensive case management services to clients… more
- Emanate Health (Covina, CA)
- …of experience required. Experience includes: hospital billing and collection experience such as clinical denials or reference to a denials management ... Specialist is responsible for denial and AR management as defined by Denial Manager . The Denial Specialist will possess and apply thorough knowledge of collections… more
- Nuvance Health (Danbury, CT)
- …departments, team members, providers, delegates, and community partners. In addition, the Manager Denials Prevention & Appeals Operations is responsible ... coaching and feedback to team members. * Collaborate with Manager Denials Prevention & Appeals ... management into other internal and external teams/departments including Denials Management and Care Coordination * Conduct clinical… more
- Catholic Health (Buffalo, NY)
- …8-4 with varied hours based on role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for ... include setting up arbitration between parties. This individual provides clinical oversight to the clinical denials... areas and third-party payers in scenarios related to denials and appeals . This position educates all… more
- 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
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