- 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, ... *PER DIEM** * *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
- 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
- Stanford Health Care (Palo Alto, CA)
- … follow-up, denials appeals , denial and write-off analysis, and denials prevention . The Director operates as the enterprise expert and spokesperson for ... Denials Management serves as the strategic leader and leads all denials prevention and management activities for the Stanford Health Care enterprise… 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
- Mayo Clinic (Rochester, MN)
- …defend coding-related denials . Experience in utilization review, case management, denials and appeals , revenue cycle, or prior authorization preferred. ... review, and levels of care criteria. Familiarity with Medicaid and Medicare claims denials and appeals processing and regulatory requirements. Knowledge and use… 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
- 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