supply on hand. Assists patients/customers in resolving identified problems. Proactively identifies patients with clinical... authorizations and/or financial assistance application. Performs prior authorizations, appeals, and tier exceptions as necessary...
issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, dental... Grievances and appeals submissions Utilization management intake or status Complex pharmacy inquiries Complex spending account...
. Submits clinical data to third party payors and documents authorization in electronic medical record system. Performs... continued stay reviews based on intensity of service, clinical response to care, expected length of stay and readiness...
of benefits (EOB) statement Analyze A/R (Accounts Receivable) reports to follow up on unpaid claims Send out appeals on claims... clinical care. LogixHealth was founded in the 1990s by physicians to service their own practices and has grown to become the...
Appeals, detailed Clinical Documentation, and Peer to Peer reviews. Educating the HCPs on gaining access to prescribed... with all company policies and standard operating procedures. Ensure training is completed and demonstrate appropriate clinical...
payment of treatment stays and timely appeals of denied cases. Works closely with the Directors of Clinical, Intake...
actions to obtain account resolution Submits appeals, as appropriate, for all non-clinical denials Monitors all denials...
payment of treatment stays and timely appeals of denied cases. Works closely with the Directors of Clinical, Intake...
presentations. Oversees the high denial outreach/non-responder/high appeals initiative in all markets, initiating clinical...
and Complex Denials unit, ensuring the accurate and timely resolution of coding-related denials, appeals, and escalations... standards while fostering collaboration across the Clinical Revenue Office (CRO). Responsibilities Operations: Oversee the...
professionals who are continuously discovering clinical innovations and enhancing access to the most up-to-date facilities... and appeals; Provide timely reports to management on claim status and potential areas for mitigation; Analyze claim trends...
and FPI leadership as well as physician, clinical and administrative staff for physician and hospital specialized, high-cost... as necessary, and engages and secures buy-in of UMMC, FPI and physician leadership, clinical and administrative staff for awareness...
, risk adjustment and appeals and grievances. Serves as clinical advisor to and educator of medical management staff making... clinical teams and utilization review processes. Job Description Manages and leads Health Plan's medical directors...
and Appeals Reviewers, Program Managers and the Clinical Manager. The Disability Assistant makes complex decisions regarding...Overview: POSITION SUMMARY: Under the general supervision of the Clinical Manager or designee, this position...
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...
for continued care stays with a high degree of collaboration with clinical therapist and other patient care staff required. Provides... current episode of care as well as anticipated future clinical care. Pursues pre authorization and concurrent review...
), you will utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer...
medical necessity/appropriateness for specific drugs and based on clinical criteria. Responsibilities: Responsible... through clinical therapeutic interchange to facilitate formulary compliance, optimize generic dispensing, and consistency...
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...
collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care... and Clinical Outcomes. It is home to nine university affiliated residency programs. Here, you will find a Level II trauma center...