- Dayton Children's Hospital (Dayton, OH)
- …and Resource Management; supports the development and implementation of a comprehensive denials management program. This role functions as a hospital liaison with ... pre certify accounts, and appeal observation, inpatient, medical necessity, and DRG insurance denials . This role functions as an internal liaison for members of the… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care ... external third-party payers to appeal denied claims and retrospectively identifies appeals determination as indicated through research and coordination of completion… more
- Northwell Health (Melville, NY)
- …current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect patient's severity of illness ... of job entry date. Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed. Preferred… more
- St. Luke's University Health Network (Allentown, PA)
- …revenue due to denials and rejections. + Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on ... a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party...revenue and trending. + Coordinates RAC appeals for complex case reviews for medical necessity, including… more
- Houston Methodist (Sugar Land, TX)
- …processes, managed care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of CPT and ICD codes ... At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing...review activities, and monitoring the clinical denial management and appeals process, as applicable, in collaboration with clinical team… more
- UNC Health Care (Goldsboro, NC)
- …all denial requests and leads the team in the strategy to appeal all clinical denials . Provides the clinical expertise to draft the first and second levels of an ... the Physician Advisors and subject matter experts for all audit and appeals work activities. Assists with documentation review to support the clinical documentation… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …revenue cycle teams. The UM Analyst helps ensure regulatory compliance, timely appeals , and reduction of avoidable denials through proactive collaboration and ... years of experience in clinical care, utilization review, case management, or clinical denials / appeals -OR- * An approved equivalent combination of education and… more
- UHS (Binghamton, NY)
- Position OverviewUnited Health Services (UHS) is seeking a proactive and analytical Clinical Denials Specialist to join our Revenue Cycle team. In this vital role, ... you will focus on the prevention and resolution of clinical claim denials by analyzing denial patterns, investigating and appealing denied claims, and collaborating… more
- Intermountain Health (Denver, CO)
- **Job Description:** The RCO Audit & Appeals RN Consultant is responsible for consulting on clinical Appeals and Audits for Intermountain Health. The Audit/ ... of medical records on behalf of Intermountain hospitals and clinics for denials review, defense audits, disallowed charges, and retrospective reviews, and will serve… more
- R1 RCM (Salt Lake City, UT)
- …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