• Registered Nurse Clinical Denials

    Catholic Health (Buffalo, NY)
    …liaison between front-end clinical areas and third party payers in scenarios related to denials and appeals . This position educates all members of the patient ... position is accountable for carrying out and documenting the appeals process for denied claims denied due to reasons...on an ongoing basis in relation to trends in denials , and clinical documentation. Responsible for working alongside coding,… more
    Catholic Health (04/23/25)
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  • Coding Charges & Denials Specialist…

    Houston Methodist (Houston, TX)
    …coding staff; and functions as clinical subject matter expert related to coding denials and appeals . **PEOPLE ESSENTIAL FUNCTIONS** + Communicates openly in a ... At Houston Methodist, the Coding Charges & Denials Specialist is responsible for coordinating and monitoring the coding-specific clinical charges and denial… more
    Houston Methodist (04/15/25)
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  • AR Appeals Specialist

    TEKsystems (Addison, TX)
    …processes, claim adjudication, and reimbursement methodologies. - Familiarity with insurance denials , appeals , and arbitration processes, including knowledge of ... reimbursement issues to identify the root causes. - Initiate and manage the appeals and arbitration process for denied or underpaid claims, ensuring timely and… more
    TEKsystems (05/06/25)
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  • Specialist, Appeals & Grievances

    Molina Healthcare (New Haven, CT)
    …subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers... appeals and denials . + Strong verbal and written communication skills To… more
    Molina Healthcare (04/30/25)
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  • Manager - Utilization Review & Denials

    Beth Israel Lahey Health (Plymouth, MA)
    …status of completion. + Reviews and determines appropriate strategy in response to reimbursement denials . + Responsible for appeals and follow up on clinical ... a difference in people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who We Are:** At **Beth Israel… more
    Beth Israel Lahey Health (04/29/25)
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  • Clinical Appeals Coordinator - Pennsylvania…

    Penn Medicine (Philadelphia, PA)
    …shortages.Coordinator is responsible for management of lists and processes related to denials and appeals .Coordinator also prepares quarterly denial reports by ... future each day. Are you living your life's work? **Summary:** + The Clinical Appeals Coordinator will play an essential role in maximizing collection of revenue for… more
    Penn Medicine (04/29/25)
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  • Physician Advisor Denials Management

    CommonSpirit Health (Phoenix, AZ)
    …denied claims to determine validity and identify opportunities for overturning inappropriate denials . Leads the appeals process by providing clinical expertise, ... needs of patients and alternative levels of care. **The PA performs denials management and prevention in accordance with the organization's goals and expectations.… more
    CommonSpirit Health (04/11/25)
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  • Clinical Appeals Supervisor

    R1 RCM (Chicago, IL)
    …will help support clinicians who conduct a comprehensive review of clinical denials and formulate appeals based on clinical documentation, evidence-based medical ... patient care as well as conceptual knowledge of the denials landscape. Proficiency in basic computer skills is essential...**Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor the workflow of… more
    R1 RCM (04/18/25)
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  • Clinical Coding Appeals Supervisor

    R1 RCM (Chicago, IL)
    …coders and coding team members who conduct a comprehensive review of coding denials and formulate appeals based on documentation and/or make coding change ... what you will experience working as a Clinical Coding Appeals Supervisor:** + Track daily inventory of cases and...and quality goals. + Track, evaluate, and report overturned appeals . + Audit a sample of appeals more
    R1 RCM (04/12/25)
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  • Medical Billing Specialist- Clinical…

    TEKsystems (San Bernardino, CA)
    …1+ Years of experience in reviewing medical records 1+ years of experience in appeals and denials High School Diploma On-Site Monday- Friday 8-5 Pay and ... Description The ideal candidate will be responsible for managing clinical denials related to medical necessity, level of care, and delays in service. This role… more
    TEKsystems (05/01/25)
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