Job Summary: The purpose of this position is to ensure accurate and timely management of medical claims by handling... companies and payors to collect essential information, including claim statuses, denial reasons, and any additional relevant...
Management Nurse Specialist - IP/OP , you will: Review denied claims, evaluate denial reasons, and carry out the appeals process... in a timely and accurate manner. Submit retro-authorizations and conduct medical necessity reviews based on denial root causes...
medical necessity reviews based on denial root causes. Prepare and submit compelling written appeals based on clinical... denial reasons, and carry out the appeals process in a timely and accurate manner. Submit retro-authorizations and conduct...
Denials & Appeals Nurse Specialist (IP & OP) , you will: Review denied claims, evaluate denial reasons, and carry out the... appeals process in a timely and accurate manner. Submit retro-authorizations and conduct medical necessity reviews based...
& Appeals staff. Escalate production or QA concerns to management and collaborate with Training teams to ensure progress... and consistency. Demonstrate strong knowledge of production workflows, quality processes, and documentation standards in medical...
, for all Clinical Denials & Appeals staff. Escalate production or QA concerns to management and collaborate with Training teams... standards in medical diagnoses and treatment practices. Conduct QA audits, maintain detailed QA records, and provide...
& Appeals staff. Escalate production or QA concerns to management and collaborate with Training teams to ensure progress... and consistency. Demonstrate strong knowledge of production workflows, quality processes, and documentation standards in medical...
, for all Clinical Denials & Appeals staff. Escalate production or QA concerns to management and collaborate with Training teams... standards in medical diagnoses and treatment practices. Conduct QA audits, maintain detailed QA records, and provide...
) teams to resolve mismatched DRGs and improve documentation. Participate in denial management and appeal processes related..., DRG/APC assignment. Experience with hospital-based coding audits, denial management, and EMR systems (e.g., 3M, Optum...
. Perform accounts receivable collections, follow-up, denial management, claims payment processing, tracking, and appeals... Receivable/Collections in a BPO setting. Familiarity with UB Claims and UB04 forms. Experience in medical billing/AR collections...
). Dispute Resolution & Denial Management Investigate claim denials or underpayments, obtain supporting clinical/billing... collections and improved cash flow for infusion services. The Impact you'll make Accounts Receivable Management Monitor and manage...
mismatched DRGs and improve documentation. Participate in denial management and appeal processes for coding-related issues... in hospital-based coding audits and denial management Strong knowledge of ICD-10-CM, ICD-10-PCS, CPT, and DRG/APC assignment...
collections; no direct patient outreach). Dispute Resolution & Denial Management Investigate claim denials or underpayments...Medical Biller & Collections Specialist - Freelance, Remote Department: Support & Leadership Employment Type: Full...