a leadership role with the interdisciplinary team to achieve optimal quality, clinical and resource outcomes. Works to provide... a comprehensive range of services or clinical care associated with and in accordance with standards of excellence established...
-site locations as necessary. Gathers necessary clinical information and processes referrals, pre-certification, pre... and denials. Responds in a timely manner to last minute/emergency referrals or additional codes performed during a procedure...
. Responsible for data driven continuous improvement initiatives regarding quality performance, clinical outcomes and IT system... in coordination with FHES Management, IT support and clinical staff systems to ensure process changes and development of future...
for mentorship and career growth. A diverse patient population and rewarding clinical experiences. Join Our Team: If you're... claims and processing refunds when necessary. Reviewing insurance denials and actively working accounts for payment...
-site locations as necessary. Gathers necessary clinical information and processes referrals, pre-certification, pre... and denials. Responds in a timely manner to last minute/emergency referrals or additional codes performed during a procedure...
necessary clinical information and processes referrals, pre-certification, pre-determinations, and pre-authorizes... according to insurance plan requirements. Logs, tracks and reviews managed care approvals and denials. Responds in a timely manner...
management follow up. Attends clinical in-services or required operational/clinical training sessions. * Act as a resource... and accurately follows Health Plan and/or Medicare Guidelines when issuing denials. Ensures that all denials for medical necessity...
with the peer-to-peer coordination, and denials / appeals tracking. This position serves as a liaison between the Case... department staff regarding clinical insurance review completion and/or issues. Forwards the necessary patient clinical...
collaboratively with Revenue Cycle Management and clinical teams for claim and authorization denials for specific plans ● Maintains.... Communicates effectively with external and internal customers (e.g. Revenue Cycle Management, Finance, Operations, and clinical...
and demonstrated knowledge and expertise in using tools such as the Microsoft suite of products. LNA or other clinical license..., tracking metrics and deliverables. Areas of responsibility include claim denials, ABNs, authorization issues and subsequent...
requests for drug authorizations or denials. Review of prior authorization criteria for drug products. Recommend staffing... and/or additional information when necessary. Consult with staff clinical pharmacist for guidance and assistance as necessary...
to the Office or reporting denials to the Regional Operations Director/ Branch Manager Secure approval to assess on all new..., denials must be approved by Branch Manager or Regional Operations Director Discharge of a Client must be approved by the...
that all referrals are accepted that are offered to the Office or reporting denials to the Regional Operations Director/ Branch Manager... Accept all referrals to the assigned office, denials must be approved by Branch Manager or Regional Operations Director...
to the Office or reporting denials to the Regional Operations Director/ Branch Manager Secure approval to assess on all new..., denials must be approved by Branch Manager or Regional Operations Director Discharge of a Client must be approved by the...
-authorization, concurrent reviews and appeals/denials management throughout the duration of a consumer’s stay. Assists the treatment... is designed to facilitate and ensure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic...
for contacting external case managers and managed care organizations for pre-authorization, concurrent reviews and appeals/denials... of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive admission and concurrent review...
guidelines and criteria for designated setting and status. Collection of clinical information necessary to initiate commercial... also need to notify physician and patient of authorization denials. Inputs collected data into computer system for insurance...
guidelines and criteria for designated setting and status. Collection of clinical information necessary to initiate commercial... also need to notify physician and patient of authorization denials. Inputs collected data into computer system for insurance...
of improvement identified through utilization review, clinical records audit, claim denials, member satisfaction surveys...
with the peer-to-peer coordination, and denials / appeals tracking. This position serves as a liaison between the Case... department staff regarding clinical insurance review completion and/or issues. Forwards the necessary patient clinical...