that treatment regimen is appropriate. Process referrals and submit clinical supporting documentation to insurance carriers... as required. Look through denials and submit appeals if requested by physician to get them approved from insurance companies. Document...
criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians... II pediatric trauma designations. The advanced capabilities and clinical expertise within this center have earned it...
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...
) 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...
for annual CDT changes, including new codes coverage and clinical rules. Oversee claims appeals escalated from the UM Department...Job Description: Department Summary Provide clinical dental expertise and recommendations to support growth...
that drive better clinical outcomes and operational efficiency. This position is full-time. Employees are required to work...-based complaints and appeals. Collaborate with department leaders, risk management, quality, and compliance teams...
office protocols, policies, and procedures including use of lab and supply formulary Perform quality clinical... and Clinical leaders Assist in the training of new hygienists and dental assistants Provide input to OM for annual performance...
-up with management. Facilitates resolution of complaints, concerns, appeals, and grievances relative to compliance... initiatives, or workflows relating to clinical, billing, coding, or other activities pertinent to the Compliance Program...
will have experience: Full cycle medical billing ECW (E-Clinical Works) electronic medical records experience Prefer someone with Family... and authorization Data entry and electronic claim filings Experience with out of network claims and appeals Following up on claims...
to schedule medication deliveries and verify correct address information. Escalates calls to pharmacists for clinical inquiries... with required prior authorization and required appeals. Manage all mail/delivery of Rx orders including addressing problems/issues...
, 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...
third-party claims and standard appeals, using various JHM applications and JHU/ PBS billing applications. Communicates... payments and possess a knowledge of appeals and rejections processes to resolve standard issues or escalate to a more senior...
third-party claims and resolution of non-standard appeals, using various JHM applications and JHU/ PBS billing applications... registration information (demographic and insurance) as needed. Resolves claim edits Drafts and resolves non-standard appeals...
requests, review of emergency department visits, review of appeals, and consultations with nurse case managers.... Qualified candidates will have 5 years of clinical experience with progressively responsible leadership experience. Health plan...
third-party claims and resolution of non-standard appeals, using various JHM applications and JHU/ PBS billing applications... registration information (demographic and insurance) as needed. Resolves claim edits. Drafts and resolves non-standard appeals...
and development of improved strategies to benefit high risk patients. Provides clinical review against standard criteria for the... potential denials are determined and files appeals when denials are received. Partners with physician related to resource...
in the area of PB Charge Review, HB Claim Edits, PB/HB coding-related De nials, Rejections, and the Quality of HB Appeals... and/or professional charges. · Consult with and provide feedback to physicians or departments. Communicate with clinical, ancillary...
to schedule medication deliveries and verify correct address information. Escalates calls to pharmacists for clinical inquiries... with required prior authorization and required appeals. Manage all mail/delivery of Rx orders including addressing problems/issues...
, clinical history, and dependent responsibilities, must be conducted in a precise manner based on knowledge and interpretation... and /or judicial appeals. There is legal liability involved for the Medicaid Eligibility Analyst, as they are responsible to the county...
I: Master’s degree in behavioral health field including Counseling, Psychology or Social Work; OR PhD/PsyD in Clinical... or Counseling Psychology. . Obtain Alaska Clinical Licensure in designated field within four (4) years of hire. Qualifications...