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...
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...
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...
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...
) 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...
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...
, and procurement matters. Advises on and oversees internal PCHP investigations, grievances, and appeals related to compliance... contracts, including agreements for clinical services, managed care and commercial payor relationships, complex transactions...
Precertification with payors. Concurrent Clinical review with payors. Document in the electronic system daily in real time... information. Reconsiderations, assists with appeals as needed, arrange peer to peer level reviews, and report the outcomes to the...
. Coordinates Peer to Peer as needing with the referring physician. Submits appeals as required. · Participates in workflow... under the direction on Non-Clinical Coordinator Facilitate team meetings as needed Emphasizes customer service, and actively...
manner by completing appeals as needed or driving materials and accounts through the Plan Manager to the Payer. ESSENTIAL... to ensure contractual payment of submitted claims and Resubmit claims and write appeals to insurance companies Collaboration...
billing questions. Coder-appeals Denial Specialist are also responsible for ensuring accuracy as well as verifying completed... and precise medical record(s) for the interpretation of clinical documentation completed by the medical staff to correctly assign...
to maximize service to patients. Provides timely, pertinent insurance benefits information to clinical staff so... in preparing appeals when payment has been denied by insurance companies. Assists in the implementation of the Hospital Utilization...
to maximize service to patients. Provides timely, pertinent insurance benefits information to clinical staff so... in preparing appeals when payment has been denied by insurance companies. Assists in the implementation of the Hospital Utilization...
of healthcare revenue cycle experience with a background in claims submission, analysis, follow-up and/or denials appeals... claims. Processes complex appeals. Assists the Supervisor in developing and providing staff training. Including creating...
with managed care and coding departments to maintain accuracy in clinical and billing information... diagnosis as well as meets insurance specific guidelines. May perform clinical trial insurance verification and authorization...
of healthcare revenue cycle experience with a background in claims submission, analysis, follow-up and/or denials appeals... claims. Processes complex appeals. Assists the Supervisor in developing and providing staff training. Including creating...
PREFERRED: Academic healthcare experience One (1) year of UM/Care Coordination experience Clinical experience with specialty... professionals, community and state agencies in this effort. Serves as an advanced clinical resource to the team. Serves...
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...
of healthcare revenue cycle experience with a background in claims submission, analysis, follow-up and/or denials appeals... claims. Processes complex appeals. Assists the Supervisor in developing and providing staff training. Including creating...
’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...