- Nuvance Health (Danbury, CT)
- …delays in reimbursement. This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to all payers, ... * *Hybrid/Remote* * *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions...initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within… more
- Nuvance Health (Danbury, CT)
- *Description* *Summary:* The Manager, Denials Prevention & Appeals Operations is responsible for the direct oversight of daily operations of clinical ... stays/days are approved for medical necessity. This position will work closely with the Denials Prevention & Appeals Administration Manager to guide the… 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 , ... related to denial turnaround times, appeal success rates, and denial reduction targets. * Denials Prevention * . Analyze denial patterns to identify root causes… more
- UHS (Binghamton, NY)
- …vital role, you will focus on the prevention and resolution of clinical claim denials by analyzing denial patterns, investigating and appealing denied ... Position OverviewUnited Health Services (UHS) is seeking a proactive and analytical Clinical Denials Specialist to join our Revenue Cycle team. In this… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …years of experience in clinical care, utilization review, case management, or clinical denials / appeals -OR- * An approved equivalent combination of ... plays a critical role in reviewing, appealing, and preventing clinical denials related to medical necessity, level-of-care,...to track authorization rules, contacts, and changes supporting a denials prevention program * Collaborate with UM… more
- Fairview Health Services (St. Paul, MN)
- …the development of denial reports and other statistical reports. + Collaborates with Clinical Denials Nurse Specialist and Leadership in high-dollar claim denial ... and communicating trends and root cause to support future prevention with internal customers and stakeholders as well as...appeals or re-billing of claims to resolve coding denials to ensure collection of expected payment and mitigation… 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
- CommonSpirit Health (Englewood, CO)
- …and identify opportunities for overturning inappropriate denials . Leads the appeals process by providing clinical expertise, crafting compelling appeal ... discuss the needs of patients and alternative levels of care. **The PA performs denials management and prevention in accordance with the organization's goals and… more
- Nuvance Health (Danbury, CT)
- …strategic leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while ... Leader* will be responsible for leading a team encompassing utilization review and denials / appeals specialists and will need to foster a culture of… more
- Beth Israel Lahey Health (Plymouth, MA)
- …concurrent and retrospective reviews for level of care and continued stay * Lead appeals of clinical denials and collaborate with physician advisors * ... understanding of reimbursement systems. You will manage concurrent reviews, appeal clinical denials , and support accurate level-of-care determinations. Key… more