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Denials (Authorization) Coordinator (PD)
AHMC Healthcare - Riverside, California, United States, 92504 2 days ago
Overview:Performs quality improvement measures and processes in collaboration with the Case Management Department and Utilization Review Committee. In...
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Prior Authorization Nurse ( Review Nurse )
Regal Medical Group - Los Angeles, California, United States, 16 days ago
Job DescriptionPosition Summary:The role of the Denial Nurse is to promote the quality and cost effectiveness of medical care by applying clinical acu...
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Prior Authorization Specialist
Riverview Orthopedic Clinic - Crookston, Minnesota, United States, 56716 16 days ago
Overview:RiverView Health, is a community owned, membership based non-profit organization that was formed in 1898 and continues to be the sole communi...
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Contract Variance Specialist: Authorizations & Denials
Saint Francis Health System - Tulsa, Oklahoma, United States, 74145 15 days ago
Current Saint Francis Employees - Please click HEREto login and apply.Full TimeHours: Monday - Friday | 8am - 4:30pmPlease note: This position will be...
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Prior Authorization Specialist
Twin Cities Pain Clinic - Minneapolis, Minnesota, United States, 55400 7 days ago
Position Title: Prior Authorization SpecialistSupervisor: Prior Authorization ManagerFLSA Status: Non-ExemptMission:To provide our patients and commun...
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Prior Authorization Specialist
Curant Health - Smyrna, Georgia, us, 30081 2 days ago
JOIN A LEADING HEALTHCARE COMPANYAt Curant Health, our vision is Personalize healthcare driven by choice and defined by value. As a Curant Health empl...
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Go to next pageAHMC Healthcare - Riverside, California, United States, 92504
Overview:
Performs quality improvement measures and processes in collaboration with the Case Management Department and Utilization Review Committee. Interprets medical information used in the processing of payments and claimsResponsibilities:Investigates denials by third party payers and crafts thorough appeals to justify medical necessity. Develop, establish, and implement uniform processes and procedures for the successful appeal of payer downgrades and denials in a manner that meets all payer requirements for accuracy and timeliness. Also ensures that appeals are managed within required timeframes for maximum reimbursement. Compiles reports. Prepares and assigns record review for Medical Staff Committees. Assists in determining data formatting and types of indicators and studies. Assist in staff education in preventing denials.Qualifications:Graduate from an accredited school of nursing preferred; baccalaureate degree preferred or > 5 years experience in an acute care facility with denials experience. Possesses both good oral and written communication skills. Demonstrated interpersonal relationships in a manner which enhances communication, promotes conflict resolution and facilitates staff development. Requires knowledge or understanding or integration or software and hardware. Demonstrates a willingness to learn new programs and obtain further education regarding computerization. Knowledge in ICD Coding preferred.
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Denials (Authorization) Coordinator (PD)