- Baptist Memorial (Memphis, TN)
- …outcome. Specialist may be required to defend appeal in a payer hearing or clinical meeting when indicated. The Denial Mitigation-Appeal Specialist II RN may ... Overview Specialist- Denial Mitigation II RN Job Code: 21432 FLSA...cycle as demonstrated by the following: Performs reviews of clinical information and supporting documentation for acute care inpatient… more
- Baptist Memorial (Memphis, TN)
- …outcome. Specialist may be required to defend appeal in a payer hearing or clinical meeting when indicated. The Denial Mitigation-Appeal Specialist II RN may ... Overview Specialist- Denial Mitigation II RN Job Code: 21432 FLSA...cycle as demonstrated by the following: Performs reviews of clinical information and supporting documentation for acute care inpatient… more
- Sutter Health (Sacramento, CA)
- …recent relevant experience. * 2 years experience in Utilization Management (UM) and Clinical Denial Management Preferred **SKILLS AND KNOWLEDGE:** * Knowledge of ... resources post-acute agencies, patients and their families. **Job Description** : ** EDUCATION :** * Graduate of an accredited school of nursing **CERTIFICATION &… more
- Avera (Sioux Falls, SD)
- …(CMS). Be apart of something great! **Position Highlights** **Position Summary** The Denial Prevention Analyst coordinates facility wide denial and denial ... trends in order to identify and implement prevention opportunities. Furthermore, the Denial Prevention Analyst works accounts in Denial Management desktop to… more
- Nuvance Health (Danbury, CT)
- *Description* *Summary:* *Associate Compliance Officer ("ACO"), Clinical Audit, Quality and Revenue Cycle* Consistent with legal requirements and compliance ... performing Clinical Audit Activities across Nuvance Health, ensuring accurate quality processes and supporting SACO and Senior Compliance Officer ("SCO") in… more
- University of Michigan (Ann Arbor, MI)
- …Assist with audits, appeals, and peer-to-peer reviews. Collaborate with coder/biller education + Denial reporting. Establish review parameters and identify ... + Current RHIT, RHIA or CPC certification + Demonstrated experience providing clinical documentation and coding education to providers + Excellent communication… more
- Kaleida Health (Buffalo, NY)
- …to promote effective clinical validation improvement and clinical denial management system-wide. Significant influence on system quality and financial ... to successfully execute, support, implement, and monitor the DRG and Utilization Management Clinical Denial teams Work Plan and, assists in the development and… more
- University of Miami (Hialeah, FL)
- …tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Concurrent Quality Reviewer of our hospital reviews documentation ... accuracy of documentation by collaborating with the providers, CDIs, Coders, Quality , and other relevant multidisciplinary teams. The concurrent inpatient quality… more
- Stanford Health Care (Palo Alto, CA)
- …Payer Communication, Level of Care Appropriateness Coordination, Admission Status Determination, Clinical Denial Prevention ** Education Qualifications** + ... Management: Federal/State/Local Regulatory Agency Compliance, Joint Commission Standards Compliance, Clinical , Documentation Education /Support, Clinical Guidelines/Pathways/Evidenced… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …gather clinical information to support the plan of care. + Monitor clinical quality concerns, make referrals appropriately, identify and escalate quality ... with emphasis on utilization management, discharge planning, care coordination, clinical outcomes, and quality of service by...complex cases as appropriate or when question of potential denial of services is identified. + Refer to Physician… more