- Sanford Health (Sioux Falls, SD)
- …clinical documentation, and interpreting medical policies. The As a lead position, lead appeals and denial specialist this role will additional support ... and possesses the ability to identify resources and support processes for the appeal and denial team. Serves as the go to source for complex questions and… more
- Baptist Memorial (Memphis, TN)
- Summary The Denial Mitigation Specialist - Denial Escalation Quality Assurance evaluates the adequacy and effectiveness of internal and operational controls ... designed to ensure that processes and practices lead to appropriate adjudication of claims. This role requires thorough understanding of regulatory requirements,… more
- Trinity Health (Hartford, CT)
- …continual basis with the Collections Manager + Review EOB denials and identifies denial trends along with solutions for resolution + Run accounts receivable aging ... Identify claims that need to be appealed and process appeal in a timely manner + Establish working relationship...and perceiving our world and that these differences often lead to innovative solutions. Our dedication to diversity includes… more
- Sevita (Sterling Heights, MI)
- …the United States. Our extraordinary team offers innovative, quality services and support that lead to growth and new opportunities for the people we serve and for ... impacts the lives of others? In the AR Collections Specialist role, you will contribute to the company's commitment...in the US. **_Responsibilities:_** + Review and work in Denial Workflow (DWF) for tasks with follow-up dates that… more
- Sevita (Charlotte, NC)
- …a company that positively impacts the lives of others? In the AR Collections Specialist role, you will contribute to the company's commitment to serve others by ... in the US. **_Responsibilities:_** + Review and work in Denial Workflow (DWF) for tasks with follow-up dates that...follow the credit balance procedure for resolution + Prepare appeal packet as required by payer, scan and save… more
- LifePoint Health (Brentwood, TN)
- …Develop and monitor key DRG Downgrade KPIs. . Assure appropriate action is taken within appeal time frames to address DRG downgrade denial . . Serve as subject ... leadership. This position also provides oversight to the DRG Downgrade Appeals Specialist team. *Responsibilities:* . Oversee the operations and human resource needs… more
- LA Care Health Plan (Los Angeles, CA)
- …Summary The Supervisor, Authorization Technician supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the ... inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance/ appeal requests, and prepares UM Activity and Weekly Compliance… more
- Fairview Health Services (St. Paul, MN)
- …claim DRG downgrade denials related to coding and clinical determination to support appeal strategy, tracking by disease, payer and denial activity and works ... national data and remains current with payer trends needed to educate and lead teams to achieve benchmark performance. + Develop and monitor internal key performance… more
- General Dynamics Information Technology (Washington, DC)
- …and initiating staffing for approval. + Coordinating access approval or denial process with appropriate access approval authority. + Preparing documentation to ... notify appropriate personnel of access approval or denial . + Conducting program debriefings and processing of relevant documentation (eg, SAP nondisclosure… more
- General Dynamics Information Technology (Washington, DC)
- …and initiating staffing for approval. . Coordinating access approval or denial process with appropriate access approval authority. . Preparing documentation to ... notify appropriate personnel of access approval or denial . . Providing advice to the Program Security relating...issues, including the procedures to be followed in the appeal processes. . Providing proper protection for privacy information.… more