Clinical Denial Specialist

The Clinical Denial Specialist writes and submits professionally written appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language. Appeals are submitted timely and tracked through final outcome.

The Clinical Denial Specialist writes and submits professionally written appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language. Appeals are submitted timely and tracked through final outcome.

The Clinical Denial Specialist conducts comprehensive reviews of the claim denial, account/guarantor notes associated with the denial, and the medical record to make determinations if a revised claim needs to be submitted, if a retro authorization needs to be obtained, if a written appeal is needed, or if no action is .

The Clinical Denial Specialist conducts comprehensive reviews of the claim denial, account/guarantor notes associated with the denial, and the medical record to make determinations if a revised claim needs to be submitted, if a retro authorization needs to be obtained, if a written appeal is needed, or if no action is .

Performs advanced level work related to clinical denial management. The individual is responsible for managing claim denials related to referral, authorizations, notifications, non-coverage, medical necessity, and others as assigned.

Performs advanced level work related to clinical denial management. The individual is responsible for managing claim denials related to referral, authorizations, notifications, non-coverage, medical necessity, and others as assigned.

Shift Schedule: NightshiftWork Setup: HybridSummary:The clinical support specialist (CSS) provides administrative support to clinical staff within Member Health. The CSS adheres to established customer service standards of accuracy, courtesy, and professionalism. This position supports timely determination turnaround times on all prior authorization requests...

the Quality Assurance (QA) Specialist is responsible in ensuring accuracy of information and quality of delivery by monitoring, auditing,reviewing, analyzing, documenting work processes that further improves clinical operations standards. Performs quality audits, validates resultsand communicates recommendation among responsible departments. Participates in...

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the Quality Assurance (QA) Specialist is responsible in ensuring accuracy of information and quality of delivery by monitoring, auditing, reviewing, analyzing, documenting work processes that further improves clinical operations standards. Performs quality audits, validates results and communicates recommendation among responsible departments. Participates...

Job DescriptionThe Medical Biller is responsible for a broad range of billing functions byproviding operational support through the full billing cycle: duties include accounts reviews/billing, payment posting,billing, claim submissions, medical insurance communications, and other billing matters. In this role, theThe specialist is responsible for working,...

the Quality Assurance (QA) Specialist is responsible in ensuring accuracy of information and quality of delivery by monitoring, auditing, reviewing, analyzing, documenting work processes that further improves clinical operations standards. Performs quality audits, validates results and communicates recommendation among responsible departments. Participates...

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This role is an open-end contract position with a hybrid work setup. Please apply only if you are amenable to these terms.The Quality Improvement Specialist is responsible for ensuring the quality and compliance of utilization management processes within the organizations. They will also ensure quality and effectiveness as well as compliance with all the...

Let your Passion Lead You at the Home of Clinicians with over 4000+ employees who have trusted us with their careers!Our Clinicians and Associate advocates for better patient care while enjoying these benefits:HMO on Day 1 with 2 dependents upon regularizationGroup Life InsuranceHighly Competitive SalaryComplexity AllowanceOnsite AllowanceAnnual Salary...