Clinical Appeals RN Manager - United States

The Manager is responsible for the day-to-day Appeals and Denials process by providing general oversight including leadership for the inpatient DRG/Coding Denials and Appeals process which includes tracking prioritizing trending and writing appeal letters identifying training and ...

+In this role, you will lead the operational areas of the Utilization Management (UM) program including prospective, concurrent and retrospective reviews. · +Ensures quality and clinically sound services for all enrollees through associates and providers. · Serves as medical advi ...

This customer service representative role involves providing expertise and general support to teams in reviewing appeals and grievances, communicating with internal parties regarding issues, implications, and decisions. · ...

The Denials & Appeals Coordinator is responsible for managing, tracking, and resolving denials and appeals to ensure timely reimbursement. · ...

TMC brings physical therapy services to long term care providers. · Manage clinical documentation requests to uphold Therapy Management Corporation's standards. · Create education materials on documentation quality. · ...

The Clinical Appeals Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory requirements. · Responsibilities: · Process appeals, ensuring compliance with all regulatory milestones · Outreach to appellants or their represen ...

Analyze, triage, investigate, research and process standard and escalated appeals , complaints or state complaints from members , providers , health plans and state agencies . · Able to work overtime as needed. · ...

+ Academic Appeals Specialist + · American Public University System +The Academic Appeals Specialist is responsible for responding to student appeal requests, investigating and delivering appropriate appeal outcomes,+Responsibilities:Serves as a point of contact for first-level e ...

The Appeal Specialist II - RN reviews, analyzes and resolves insurance denials to ensure accurate reimbursement and regulatory compliance. · Reviews and resolves pre-payment insurance denials in collaboration with follow-up teams. · Coordinates with Denial Coordinators, Facility ...

As part of the SCP Health team you have an opportunity to make a difference. · - Strong track record of providing excellent work/life balance. · - Comprehensive benefits package and competitive compensation. · - Commitment to fostering an inclusive culture of belonging and empowe ...

We are committed to operational excellence, regulatory compliance, · and accurate revenue cycle management to support high-quality EMS delivery. · ...

This position reviews provider billing/claims appeals and reconsiderations, supports legal responses to medical billing disputes, and ensures compliance with Workers' Compensation regulations and best practices. · ...

The Manager shall partner with organizational leadership to oversee and optimize our centralized physician business office operations. · ...

Paramele Disability Advocates seeks a mission-driven Veterans Affairs (VA) Attorney to represent veterans in their claims for disability compensation before the U.S. Department of Veterans Affairs (VA) and the Board of Veterans' Appeals. · ...

The DRG Denials Auditor conducts hospital inpatient DRG denial audits. · Reviews patient records for accuracy in ICD-10-CM/PCS coding, DRG assignments, and supporting clinical documentation. · Evaluates present on admission (POA) indicators, discharge disposition, and any other r ...

The medical billing specialist will be responsible for all activities related to health insurance and medical billing. · ...

The Clinical Case Manager is responsible for ensuring the increased length of stay, higher levels of reimbursement, medication carve-outs, and authorization coverage throughout patient stays.Maintains an average length of stay is 22+ for assigned clients. · Maintains no more than ...

The Denials and Appeals Analyst assists in the recovery of Health System revenue by bringing denied claims to full resolution. · Responsibilitiescoordinates the appeals process for denials deemed appropriate by the Patient Financial Services Director and the Denials Manager.assur ...

Easy Truck Shop was created to simplify workflow management for heavy-duty repair professionals. · Experience with Design Thinking and User Research · Strong skills in User Experience (UX) and Visual Design · Proficiency in Prototyping · ...

Paradigm is seeking a full-time, remote Provider Appeals and Legal Liaison to lead the interface between the Medical Bill Review/Claims team and Paradigm's Legal department. · Workers' Compensation Medical Bill Review and Provider Appeals · ...