. Job Duties & Essential Functions: Provides administrative and clinical support to physicians, nurse practitioners, fellows... with insurance companies regarding denials and appeals process for denials regarding medications, supplies, procedures, testing...
-level appeals, recoveries, and potential settlements. Ability to extrapolate complex claims data and payer information..., and appeal denied claims/services. Correspond with insurance companies to resolve issues; submit appeals per payor requirements...
and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members... required with emphasis in claims, member services, appeals and grievances or prior authorizations. Must obtain Healthcare Anti-Fraud...
Coordinator) to support the processing of all dental claim appeals, clinical provider requests and dental office administrative... Specialist: Ensures appropriate adjudication of claims and appeals by analyzing complex claims, receiving clinical...
. Apply clinical review criteria, guidelines, and screen to determine the medical necessity of health care services. Consult... with physicians or practitioner consultants when reviews fail clinical review criteria, guidelines, and screens. Follow...
Job Description Essential Functions: Collaborate with healthcare providers, clinical staff, and various departments throughout Monument Health... and clinical staff to communicate the need for pre-authorizations or referrals promptly, working to prevent delays in patient care...
vision and effectively meet our members’ needs. Leads the BH clinical operations team with a strategic and growth-oriented... mindset, aiming to achieve improved clinical outcomes and reduced healthcare costs. Identifies appropriate interventions...
from physician order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals... industry in managed care, clinical support, and/or sales OR Master’s degree AND 6 years of experience in the public...
standards. A minimum of 5 years of experience claims follow-up/appeals and health plan Accounts Receivable management... and clinical information to effectively reconcile underpaid accounts and maintain documentation to support this activity. Expert...
is relatively low, with affordable housing options and a slower pace of life that appeals to families, retirees.... A Supervising Clinician at Centria is somebody who not only believes in the core clinical values we hold as a company...
is relatively low, with affordable housing options and a slower pace of life that appeals to families, retirees.... A Supervising Clinician at Centria is somebody who not only believes in the core clinical values we hold as a company...
is relatively low, with affordable housing options and a slower pace of life that appeals to families, retirees.... A Supervising Clinician at Centria is somebody who not only believes in the core clinical values we hold as a company...
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical... perspective on workplace flexibility. Position Purpose: Perform clinical/coding medical claim review to ensure compliance...
, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements and forms Review... of experience in the public or private third-party access arena or pharmaceutical industry in managed care, clinical support...
RN will report to the Appeals and Grievances Manager. In this role, you will perform accurate and timely clinical review... care experience Clinical experience WHAT'S IN IT FOR YOU: Remote opportunity Opportunity for flexible hours Gain...
one of the top hospitals in the country for clinical excellence in many services including maternity and orthopedic care, Mission...: Responsibilities: The Utilization review tech essentially works to coordinate the utilization review and appeals process as part...
to appeals/denials requirements and forms Review patient-specific information in cases where the site has specifically requested... industry in managed care, clinical support, and/or sales OR Master’s degree AND 6 years of experience in the public...
to excellence begins with the unity of our team for the care of our residents, which is reflected in our positive clinical outcomes... will be Medicaid and Medicare reimbursement. You will be responsible for the coordination and completion of clinical assessments...
to appeals/denials requirements and forms Review patient-specific information in cases where the site has specifically requested... industry in managed care, clinical support, and/or sales OR Master’s degree AND 6 years of experience in the public...
payments through the follow-up and appeals resolution processes, and acting as a functional leader or reference source... of ground-breaking, clinical and health services research in our communities Lifestyle: Live and work in the Pacific Northwest...