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Works directly with the Billing Supervisor and Coding Manager to resolve complex issues and denials through independent research and assigned projects. Assists the Billing Supervisor with the resolution of complex claims issues, denials and appeals.
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In the event of concurrent denials, the UR Clinical Specialist reviews the denial and works with the physicians on the medical staff hospital's to perform an internal secondary review to determine if there is need to downgrade the visit.
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The Ambulance Billing Specialist will participate in weekly and monthly meetings at each site and the with the centralized business office to address front end admissions issues, outstanding AR balances, billing issues, insurance issues, and denials.
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Reviews reimbursement denials from third party carriers associated with inappropriate diagnosis or procedure coding. Be our team expert for coding questions, complex cases, and coding denials.
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Duties may include, but are not limited to, reviews of insurance and denials management processes, claim and account detail, assuring quality, accuracy, timeliness and appropriateness standards are maintained and quality standards measured and achieved.
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Sentara Martha Jefferson Hospital is hiring a Revenue Cyclye Quality Assurance Specialist - Full Time Day schedule. Martha Jefferson Hospital was founded in September 1903, by seven local physicians. Knowledge of Revenue Cycle software systems required (HBOC, MCKESSON, EPIC PRELUDE/RESOLUTE.
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Inform patients on any prior authorization approvals or denials and the next step. Kindbody is a leading fertility clinic network and global family-building benefits provider for employers offering the full-spectrum of reproductive care from preconception to postpartum through menopause.
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The (FRM) will work with the ADvantage Ig Patient Support Program (HUB) to help ensure clear and transparent communication between provider and ADMA in order to help support the entire reimbursement journey from patient start form submission through payer prior authorization to appeals/denials requirements procedures and forms.
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The Clinical Authorization Specialist is also responsible for managing denials related to front-end prior authorization, biosimilar drugs, pharmacy-benefit exclusion drugs, and claims. Root causes claim denials, reprocesses, and submits claim appeals.
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Evaluate and facilitate concurrent and retrospective prior authorization denials, appeals, or payment issues until resolved to ensure proper reimbursement is received. Identify and escalate trends with insurance companies, denials, documentation/order requirements, or medical necessity concerns.
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Performs root cause analysis resulting from charge capture reconciliation, audits, and the CDM to resolve payor denials, coding/billing edits, and/or other delays or reductions to cash flow. Supports the Denials Governance Committee, focusing on denial prevention activities and performance improvement.
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Reports denials and/or delays in the pre-certification process to physicians/other health care providers and the patient. May provide information to the patient on the appropriate appeal procedures for denials.
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Coding Documentation Liaisons work collaboratively with Service Line/Domain leaders, providers, coding leaders/staff, compliance, Informatics, Revenue Integrity, Denials, and other key stakeholders to improve the quality of documentation and coding to resolve clinical documentation and charge capture discrepancies.
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Support patient access assistance from prescriber decision through to fulfillment, supporting the entire Reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms.
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The Field Reimbursement Manager will be responsible for the management of defined accounts in Urology and Oncology area, specifically supporting our client's product. The Field Reimbursement Manager will execute the collaborative territory strategic plan through partnership with internal and external stakeholders, including acting as an extension of patient support program and in other collaboration with other partners.
$155,000 - $165,000 a yearFull-timeExpandApply NowActive JobUpdated 3 days ago
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