approvals, coinsurance, copay, deductibles and authorization requirements. Initiate appeals for denied authorizations... Practical Nurse (LPN) is required. Ten years of clinical experience will be considered in lieu of license requirement...
to address formulary restrictions. Assist with the completion of prior authorizations or appeals necessary to ensure medication... all clinical needs of patients, routing all clinical interventions or counseling to a pharmacist or appropriate licensed clinician...
Business Leadership Society, including preparing and executing two appeals annually. This involves writing copy, coordinating... accordingly. The pre-employment physical for positions in clinical areas, laboratories, working with research subjects...
of behavior. 16. Works with the utilization management team to complete peer to peer reviews and initiate appeals. 17. Develops.... Knowledge of Trauma Informed Care. Licenses and Certifications Required: 1. Licensed Clinical Alcohol & Drug Counselor...
, 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...
medical and musculoskeletal pathology. The incumbent possesses the clinical evaluation and educational skills expected... pre-authorization and retro-authorization and appeals as needed. Assists with scheduling patient appointments and clinic...
of medical and musculoskeletal pathology. The Clinical Athletic Trainer possesses the clinical evaluation and educational skills... with filing charges, billing, and insurance authorizations including pre-authorization and retro-authorization and appeals...
and assignment of all incoming physician reviewer referrals and appeals to ensure that NCQA, URAC, CMS, DOH, DOL and state specific... for reporting purposes (20%) 3. Responsible to efficiently coordinate the clinical review process with contracted external review...
, imaging, and other clinical documentation. Prints patient care plans, medication order sheets and demographic information... all documentation from clinical staff during IDT meeting and enters into the EMR. Prepares all necessary paperwork for re-certifying...
an unparalleled level of service that’s easy and focused on whole health. Through our distinct clinical expertise, digital... up by verifying insurance for limits and parameters of policy. Provides resolution to grievances and appeals issues...
WVU Medicine, especially finance and clinical leadership. Utilizes internal resources and analytical skills to make... and staff 2. The director will be responsible to lead and establish strategic initiatives around clinical medical necessity...
Financial Services (billing, insurance appeals, collections) procedures and policies Intermediate skill in Microsoft Office... our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare...
technology have finally made it possible for AI to impact clinical care in a meaningful way. Tempus' proprietary platform... focus on enhancing processes in key areas such as Prior Authorization, Insurance Verification, Insurance Appeals...
with physical health care providers. Maintains communication, coordination, and connections with all Clinical Team participants... access to treatment, appeals, and complaint processes instituted by the Mercy Care RBHA. Communicates with other staff...
of medical and musculoskeletal pathology. The Clinical Athletic Trainer possesses the clinical evaluation and educational skills... with filing charges, billing, and insurance authorizations including pre-authorization and retro-authorization and appeals...
’s. Job Description Communicates with patients, 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...
with both external and internal resources, such as physicians, attorneys, clinical/vocational consultants as needed to gather data... customer complaints in a timely and thorough manner. Identifies and refers appropriate matters to our appeals, complaint...
clinical services, back-office solutions, and advanced technology. We simplify the complex, anticipate challenges, and guide..., you’ll help drive our revenue cycle by navigating insurance appeals, resolving outstanding balances, and ensuring timely...
) review, escalating payment variance trends or issues to NIC management, and generating appeals for denied or underpaid claims... coding in DCM is accurate and reflects the denial reasons. Coordinate with the Clinical Resource Center (CRC) for clinical...
-coverage/Important Message from Medicare (HINN). Discuss the case with the attending physician and if additional clinical..., and appeals in cases of retrospective denials Assist Hospital Administration and the Medical Staff in connection...