of Jackson, MI. Requirements: As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical... expertise and reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will provide...
patient encounter utilizing multiple system applications: various registration applications, clinical operating systems... cases over the phone, follow up, provide, and fax any clinical notes pertaining to the case to the insurance payors. Meets...
services. Ensures that all clinical documentation is complete, timely, and accurately reflects the services provided. Conducts... are timely and/or appeals timely and in accordance with company procedure. Meets and or exceeds the productivity standards...
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...
Maintains strong understanding of and educate our physicians, clinical teammates, patients and families regarding contracted... with Clinical teammates and health plans to identify patients with Utilization Management needs Provides member services...
averages over $1 million in annual collections. DC Coach/Practice Management: Benefit from over 15 years of clinical... with the role. By emphasizing the support structure and professional develop opportunities, it appeals to chiropractors seeking...
. Compile and present relevant data for second-level appeals. Review and make timely updates to employee reference materials... to apply our individual talents and unique perspectives in an inclusive culture, promoting diversity in clinical trials, while our shared...
. Compile and present relevant data for second-level appeals. Review and make timely updates to employee reference materials... to apply our individual talents and unique perspectives in an inclusive culture, promoting diversity in clinical trials, while our shared...
, the Chief Medical Officer will lead and directly manage the health plan’s key clinical teams and utilization review... processes. Manages and leads Health Plan's medical directors, pharmacy team, and clinical operations team which includes...
The purpose of this position is to conduct initial, concurrent, retrospective chart review for clinical financial... with physicians. Identify opportunities for expedited appeals and collaborates to resolve payer issues. Ensures/Maintains effective...
requirements, appropriate utilization of alternate levels of care, community resources, clinical documentation improvement, coding..., quality and/or compliance processes. Develop strategy and processes to reduce denials and audits. Assist with appeals...
organization that supports the clinical activity of nearly 850 clinically active faculty practicing at the University of Chicago... the receptionist is out of the office or on break. Responsibilities: Faxing and mailing appeals/redeterminations via...
availability, and discusses issues with outside auditors and the inpatient coding manager/CDI. Prepares appeals on appropriate... and appropriate departments. Utilize an audit tracking system (Cobius) to monitor audit processes, dollars at risk, and appeals...
) 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...
insurance pre-certification and prior authorization for services. Submits appeals of coverage denials. Screens and assists the..., and other medical insurance coverage Highly effective oral and written communication skills are required to communicate with clinical...
specific coding edits. Reviews and renders decisions on appeals to claim clinical coding denials for improper coding or lack... of preauthorization. Serves as resource and subject matter expert on clinical coding to internal and external customers. Abstracts...
for patient-centered care, evidence-based medicine, and lower per-capita costs; participate in the development of clinical... utilization guidelines, health management programs and clinical quality programs. Provide clinical oversight to utilization...
with a robust interdisciplinary treatment team, including nurses, psychologists, clinical pharmacists, social workers, licensed... to pay. Oversee Unit Clinical Structure * Establish and oversee interdisciplinary teams and team meetings Ensure...
requirements, appropriate utilization of alternate levels of care, community resources, clinical documentation improvement, coding..., quality and/or compliance processes. Develop strategy and processes to reduce denials and audits. Assist with appeals...
in the 21st century and align all stakeholders- patients, providers, payors, and regulators to achieve the best clinical... and contracting regarding status of open appeals. Maintain open dialogue and coordinate with leadership & contracting to ensure...