- Centene Corporation (Austin, TX)
- …appeals and grievances from a clinical perspective. Ensure that the clinical Appeals and Grievance department processes all cases in accordance with ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- St. Luke's University Health Network (Allentown, PA)
- …and/or formal meetings with auditor or payor representatives in defense of coding appeals , as needed. + Maintain necessary audit/appeal activity documents ... patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient...for outpatient/CPT payor recommendations in collaboration with the OP Coding Supervisor or Network Coding … more
- Ventura County (Ventura, CA)
- Certified Coding Supervisor - Health Information Management Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4892159) Apply Certified ... Coding Supervisor - Health Information Management Salary...for the Health Information Management (HIM) department related to coding and CDI ( clinical documentation improvement). The… more
- Covenant Health Inc. (Knoxville, TN)
- …procedures relative to coding . + Educates and assists physicians and clarifies coding versus clinical issues. + Works closely with Registration and Business ... Office personnel to resolve issues related to claims, coding , pre-cert, and denials appeals , and verifies that appropriate chargemaster rates are used. + Reviews… more
- HCA Healthcare (Nashville, TN)
- …payer websites + Escalates problem accounts/processes/trends and report opportunities to supervisor for denial prevention and coding education opportunities + ... III (CARS-III) duties + Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical /medical resources… more
- Guthrie (Sayre, PA)
- …all medical chart and account documentation in order to determine appropriate coding and initiate corrected claims and appeals . Interprets payer guidelines, ... HCPCS, modifier and linkage. 3. Initiates complex appeal procedures and submits appeals for billing resolution by utilizing proficient coding skills. Works… more
- Houston Methodist (Houston, TX)
- …in resolution. Engages the coding follow up team for any medical necessity or coding related appeals . + Assures accounts are completed and worked at a high ... required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the professional fee environment. This… more
- Peak Vista (Colorado Springs, CO)
- …and certifications that are essential to the position. + Perform self-audits and reviews/corrects Coding Supervisor audit reports to maintain a 95% coding ... clinical documentation and how it relates to medical coding , coding guidelines and payer rules. Essential...+ Provides expertise to Accounts Receivable Staff in addressing appeals for denials due to potential coding … more
- Cedars-Sinai (Torrance, CA)
- …and resolve denied or underpaid claims; prepare and submit timely, accurate written appeals with supporting clinical / billing documentations in accordance with ... may act in the absence of the lead and/or supervisor . This position may be cross-trained in other revenue...including progress notes, lab results, pathology reports, and other clinical records, to support accurate billing, appeals ,… more
- e CancerCare (Nashville, TN)
- …Work an average of 40 to 80 denials per day based on supervisor requirements and accounts assigned. Works closely with insurance carriers for reimbursement ... Recognizing their importance and relationship to patient care. Consults with appeals department for disputed medical necessity denied claims. Works and Understands… more
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