will be responsible for the processing of payments, denials, refunds, secondary claims, filing and balancing monthly spreadsheets...
wide clinical revenue management activities in an attempt to prevent insurer denials, enhance revenue, and to recover... and/or peer to peer reviews for concurrent denials. Follows departmental policy to communicate internally with physicians, care...
and acuity. This position highly impacts the ability to maximize the level of reimbursements and prevention of denials... or by phone. This responsibility is critical to ensure positive patient experience, maximize reimbursements, and minimize denials...
in denial prevention. Proactively intervenes with payers to prevent inpatient denials. Communicates any necessary information... to payers to help appeal existing denials. May coordinate the discharge planning process from patient admission to departure...
Advocate, either virtually or in person. Has solid knowledge of how various types of insurances operate related to denials... and appeals processes. Basic medical coding knowledge. Understanding of insurances, billing and denials Ability to use...
utilizing our EPM system - Nextgen to determine appropriate action. Review explanations of benefits details on denials...
system tracking security clearance statuses, access denials, revocations, and other regulatory requirements. Qualifications...
assigned work queues daily/weekly to resolve claim denials in Cerner to ensure correct reimbursement and to avoid timely filing... denials or issues, identify if another department needs to be contacted to obtain correct charge/coding information...
reinstatements, letters of guarantee, denials of services, incoming correspondence or check processing as appropriate. Processes...
) for denials and coordinate as needed. May coordinate peer-to-peer review upon provider request when members’ health conditions...
and process improvements. Performs follow up with insurance companies to ensure appropriate payment on claims, resolve denials...
for all prices; Print Medicaid for audits with corrections and claims submissions printout. Review denials; Resubmitting...
documentation of all approvals and denials, and transfers all clinical questions and judgment calls to the pharmacist. Duties...
, accelerate cash, and reduce denials. Additionally, they will be responsible for monitoring all associates who support all paper... disciplinaries including but not limited to Patient Access, Coding, Follow Up, Denials and any additional Revenue Management...
. Respond as able to in basket messages regarding the process and results. Schedule peer to peer calls, manage denials, handle...
and consistently contribute to team goals, as well as how they support greater organizational goals. Enter and work all denials...
information, researching denials and documentation, following up on claims, and maintaining compliance with department standards...: Some benefits require an employee contribution to participate. Essential Functions: Review, research and resolve coding denials...
and denials management activities as defined by the RN Discharge Coordinator and RN Utilization Reviewer. They assume a pivotal... and denials from the payors, indexing correspondence to the medical record, and faxing additional documentation...
and minimize denials through problem solving, collaboration and consensus. Accountable for administering the Carle Financial...
inpatient denials. Performs retroactive reviews on discharged patients as assigned. Communicates any necessary information... to payers to help appeal existing denials. Uses level of care criteria to justify the patient's severity of illness...