, research, and resolve claim denials and appeals for various insurance companies while identifying payment trends in an effort... status of claims, appeals, and insurance verification. · Knowledgeable with payors including Managed Care, Commercial...
unity of our team for the care of our residents, which is reflected in our positive clinical outcomes, resident and family... will be Medicaid and Medicare reimbursement. You will be responsible for the coordination and completion of clinical assessments...
as in appeals and post-conviction and post-judgment proceedings related to those matters. The clients we represent are diverse... located throughout the state, as well as an Appeals Unit, and a staff of approximately 250 attorneys and 100 other staff...
in an intensive 12-month training program designed to provide advanced didactic education and focused clinical experiences so... disease, motility disorders, nutrition, and transplant hepatology to acquire further expertise in these clinical areas. The...
hospital setting (inpatient vs. outpatient) based on medical necessity. Actively seeks additional clinical documentation... and participates in the resolution of retrospective reimbursement issues, including appeals, third-party payer certification...
and distributing various financial reports as needed Timely resolution of all claims including appeals Following up on accounts... and technological challenges that stand in the way of clinical outcomes and operational efficiency. We work with home health and hospice...
management (UM) and care management (CM) activities demonstrating clinical judgement and independent analysis, collaborating... with members and those involved with members' care including clinical nurses and treating physicians. Responsibilities...
hospital setting (inpatient vs. outpatient) based on medical necessity. Actively seeks additional clinical documentation... of retrospective reimbursement issues, including appeals, third-party payer certification, and denied cases. Monitors effectiveness...
clinical oversight to facility medical program as defined by the ACA standards Consult with medical specialists for advice... protocols, clinical policies and procedures, to include infection control and infirmary (if applicable at site), and fire...
and, in appeals, the medical necessity of previously denied services. Oral Surgery Orthopedic Surgery Orthopedic Surgery - Spine... you apprised of required turn-around time and carefully coordinates all administrative tasks so your time is spent on clinical...
Billing Specialist will be responsible for managing claim denials, appeals, insurance credentialing, and verification...-solving skills, and a deep understanding of HCA Clinical Works. Key Responsibilities: Billing & Denials Management...
Health's patient-centered telemedicine model is improving clinical outcomes and eliminating barriers to treatment, making... Contact third-party insurance payers for resolution of claims Generate appeals or reprocess claims as necessary for problem...
management teams to optimize outcomes Collaborates effectively with clinical teams, network providers, appeals team, medical...You could be the one who changes everything for our 28 million members as a clinical professional on our Medical...
and, in appeals, the medical necessity of previously denied services. Anesthesiology Chiropractic Family Practice Internal...-around time and carefully coordinates all administrative tasks so your time is spent on clinical decision-making Dane Street...
of compliance, policy, and clinical expertise. Our team is experienced in program, payment, provider, and patient integrity... as we continue to support advanced programs of policy, clinical requirements, and compliance measures at the commercial, State...
is responsible for activities that support Optum Clinical Services with regulatory and delegation contractual requirements... as outlined in the Clinical Services Delegation Oversight framework. Location: Remote/Telecommute Hours: Monday-Friday, 8am...
and Clinical Directors Liaison between Billing Department staff and IT support Monitor weekly billing productivity to ensure... reports. Process appeals online or via paper submission. Assist in reconciling deposit and patient collections. Assist...
as needed. Schedules appointments for patients when Physician Referral Services (PRS) is unavailable. Actively Participates in Clinical... and appeals. Uses data to drive decisions and plan/implement performance improvement strategies related to case management...
working in a pediatric or family medicine clinical setting as a registered nurse or a medical practice manager, knowledge... of clinical protocols related to blood lead testing and follow-up, and experience communicating complex health information...
into the practice management system. Follow up on outstanding claims, appeals, and denials to ensure timely resolution... with patients regarding balances, payment plans, and billing inquiries. Collaborate with clinical and administrative staff...