Supervisor , you will: Operational Oversight Supervise and support Clinical Denials & Appeals staff, including hiring, onboarding... resolution of clinical denials and appeals issues. Quality & Compliance Conduct Utilization Management and Clinical Denials...
efficiency. Quality & Compliance Address Utilization Management and Clinical Denials, partnering with Billing and A/R teams... to identify root causes. Stay current on Utilization Management and Clinical Denials updates and disseminate guidance to staff...
, you will: Oversee daily Clinical Denials and Appeals operations to ensure timely and accurate processing of denied claims. Set... progress and areas for improvement. Provide training and mentorship to Clinical Denials & Appeals staff and supervisors...
or covered criteria (clinical content) for our automated claims editing solution. This solution is utilized by medical insurance... payers across the United States. The clinical content could include additions, deletions or updates to diagnosis codes...
resolution of coding-related edits, billing holds, and denials. Oversee departmental budget compliance. Monitor and support... coding-related denials and partner with billing and A/R teams to identify root causes. Stay updated on regulatory and coding...
will support US-based healthcare operations by reviewing clinical cases, processing claims, conducting utilization review..., and ensuring medically appropriate and cost-effective care decisions. The role requires strong clinical judgment, excellent...
). Dispute Resolution & Denial Management Investigate claim denials or underpayments, obtain supporting clinical/billing... A nationally focused clinical specialty pharmacy that provides home infusion, specialty and compounding services...
will support US-based healthcare operations by reviewing clinical cases, processing claims, conducting utilization review..., and ensuring medically appropriate and cost-effective care decisions. The role requires strong clinical judgment, excellent...
A nationally focused clinical specialty pharmacy that provides home infusion, specialty and compounding services... standards while serving multiple states. They prioritize timely authorizations, clinical support, and high-quality billing...