of Endo products, payer policy appeals process, and the payer landscape. Leverage all resources (Tableau and other portals...) to develop and execute account support and educate sales colleagues. Ability to synthesize clinical literature and target...
requirements and policies for 250+ staff in Billing, Collections, Government, Customer Service, Variance, Appeals/Denials, and Cash...’ experience in a leadership position in the healthcare industry. Previous Denial Management Experience and clinical expertise...
requirements and policies for 250+ staff in Billing, Collections, Government, Customer Service, Variance, Appeals/Denials, and Cash...’ experience in a leadership position in the healthcare industry. Previous Denial Management Experience and clinical expertise...
and appeals per State and Federal regulations. Participates in the distribution of clinical drug information and educates...Remote Clinical Pharmacist Responsibilities: Performs prospective and/or retrospective drug utilization review...
, accrediting, and contractual requirements Determines the appropriateness of patient care services, prepares clinical appeals...Chronic Care Nurse Coordinator: MMG Cross County Montefiore is recognized nationally for clinical excellence...
all dental office protocols, policies, and procedures including use of lab and supply formulary Perform quality clinical... and Clinical leaders Assist in the training of new hygienists and dental assistants Provide input to OM for annual performance...
in timely resolution of all claim edits, reporting of candidates for bill, outbound compliant claim submission, clinical... and collection of third party payer receivables. Denials and Appeals follow-up including root cause analysis to reduce/prevent future...
Information Management (HIM), Clinical Effectiveness, and Registration. Other job duties include: improving health record... physicians and clarifies coding versus clinical issues. Works closely with Registration and Business Office personnel to resolve...
. Post denials, correcting charges, filing appeals, and following up on unpaid claims, including composing and processing... confidentiality. Apply knowledge of health insurance plans and terminology; apply practical knowledge of billing practices, clinical...
Specialty: Medical Oncology. Must hold an active D.C., Virginia or Maryland medical license. JOB SUMMARY Utilizes clinical... expertise, and reviews insurance appeals, and prospective and retrospective claims. The physician reviewer will provide...
, and other clinical professionals who consult on various processes and programs. The Behavioral Medical Director is part of a leadership... and will also advise leadership on health care system improvement opportunities. They are responsible for maintaining the clinical...
issues are resolve timely, accurately and efficiently. Works with clinical staff in relation to patient’s benefits, pricing... structure, authorizations, denial review, appeals on denials, and submission of physician adjustment requests. Assists...
offer consumers and providers an unparalleled level of service that’s easy and focused on whole health. Through our distinct clinical... requirements; informs relevant parties of all prior authorization determinations. Provides resolution to grievances and appeals...
Registered Nurse License or NJ Licensed Social Worker or NJ Licensed Clinical Social Worker Basic Cardiac Life Support..., including LOS, throughput, patient flow and denials and appeals follow up. Applies process improvement methodologies...
, precertification, reimbursement and claim denials/appeals. Assess and coordinate discharge planning needs with healthcare team members... years of clinical experience, preferred 3 years of transplant experience, preferred 2-3 years of utilization management...
payment of treatment stays and timely appeals of denied cases. Works closely with the Directors of Clinical, Intake...
greater efficiency with completing, tracking and reporting clinical denial reviews to determine appropriate appeal of patient... accounts. This individual combines clinical, business, and regulatory knowledge and skill to reduce significant financial risk...
in response to reimbursement denials. Responsible for appeals and follow up on clinical denials escalated through a work queue..., providing appropriate response supported by clinical information. Provides oversight of the appeals process and direction...
with care management teams to optimize outcomes. Collaborates effectively with clinical teams, network providers, appeals...You could be the one who changes everything for our 28 million members as a clinical professional on our Medical...
, families, physicians, clinical staff, and insurance companies to obtain information and insurance verification to ensure... quality patient care and payment of hospital accounts. Collaborates with Appeals department to overturn claims denial...