- 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)
- …Hours 5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, ... or other absences. Provide daily administrative assistance to Denial Prevention leadership and clinical reviewers. Manage incoming...Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and… more
- Oracle (Little Rock, AR)
- …arena. We are looking for a Senior Claims Denial Prevention and Appeals Specialist for providing clinical inputs to engineering for developing the Claim ... Denial Prevention and Appeals features of Oracle Health Clinical AI...appeals packets, identify trends/improvement opportunities to prevent future denials , and ensure maximum appropriate reimbursement. This role is… 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
- UNC Health Care (Kinston, NC)
- …Reviews all denial requests and leads the team in the strategy to appeal all clinical denials . Provides the clinical expertise to draft the first and ... for issues related to reimbursement, denials , status, etc. 6. Evaluates clinical denials for validity and probability to overturn, proactively gathers… 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
- 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
- BronxCare Health System (Bronx, NY)
- …arrive in letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal ... for the staff on identified deficiencies to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely… more
- Highmark Health (Harrisburg, PA)
- …in denial prevention activities. **ESSENTIAL RESPONSIBILITIES** + Reviews clinical denials , audits and accounts as assigned.Composes and submits ... Health Network **Job Description :** **GENERAL OVERVIEW:** Responsible for all aspects of clinical appeal activities to include but not limited to, clinical … 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 , ... turnaround times, appeal success rates, and denial reduction targets. ** Denials Prevention ** . Analyze denial patterns to...Serve as the primary contact with payers on DRG-related denials . Effectively communicate the clinical and coding… more