Clinical Denials Specialist

3 days ago


Melville, New York, United States Northwell Health Full time

At Northwell Health, we are seeking a skilled Clinical Denials Specialist to join our team.

About the Role:

We are looking for a highly motivated individual with experience in Case Management, Appeals & Denials, and/or Utilization Review. The successful candidate will have a strong background in nursing, with a Bachelor's Degree in Nursing preferred. As a Clinical Denials Specialist, you will play a crucial role in reviewing corporate compliance audits, identifying coding issues, and developing strategies to improve denial rates.

Responsibilities:

  • Review and respond to corporate compliance audits
  • Serve as a resource for the health system on denial trends and coding issues
  • Collaborate with physician advisors, payor representatives, and site case managers to facilitate appropriate level of care decisions and billing status
  • Perform concurrent and retrospective utilization management using evidenced-based medical necessity criteria
  • Conduct clinical reviews and formulate appeal letters to support appropriateness of admission and continued length of stay
  • Ensure compliance with current state, federal, and third-party payer regulations

Requirements:

  • Graduate from an accredited School of Nursing
  • Bachelor's Degree in Nursing, preferred
  • Current License to practice as a Registered Professional Nurse in New York State required
  • Prior experience in Case Management, Appeals & Denials, and/or Utilization Review, highly preferred

Salary Information:

The estimated salary for this position is $80,000 - $110,000 per year, depending on experience and qualifications.



  • Melville, New York, United States Northwell Health Full time

    Job OverviewWe are seeking an experienced nurse to fill the role of Clinical Denials Specialist at Northwell Health. As a key member of our team, you will be responsible for reviewing denial trends, identifying coding issues, and collaborating with healthcare professionals to resolve disputes.About the JobWork Schedule: Remote work schedule (Sun-Thurs,...


  • Melville, New York, United States Northwell Health Full time

    Job SummaryIn this role, you will serve as a liaison between patients and facilities/physicians and third-party payers. Your responsibilities will include preparing and defending level of care and medical necessity for assigned cases.


  • Melville, New York, United States Medix™ Full time

    Are you a detail-oriented individual with a passion for medical billing? Do you possess excellent organizational skills and experience working with insurance companies?Job Summary:We are seeking a highly skilled Medical Biller to join our team at Medix, a reputable healthcare organization in Melville, NY. As a Medical Biller, you will be responsible for...


  • Melville, New York, United States Catholic Health Service Full time

    Catholic Health Service offers a challenging and rewarding opportunity as an Accountable Revenue Recovery Specialist. This position plays a critical role in ensuring the timely and accurate reimbursement of patient accounts, allowing us to continue providing high-quality care to our communities.We are seeking an experienced professional with excellent...


  • Melville, New York, United States Medix™ Full time

    Medix is a leading healthcare organization based in Melville, NY. We are currently seeking a Medical Biller to join our team on a full-time, on-site basis.Job Description:The successful candidate will be responsible for processing billing for Medicare, Medicaid, and commercial payers, posting payments and adjustments to patients' accounts, and reviewing...


  • Melville, New York, United States LifeStance Health Full time

    We are a national provider of mental healthcare services dedicated to delivering evidence-based treatment for children, adolescents, and adults suffering from various mental health issues in an outpatient setting. Our team consists of psychiatrists, psychologists, psychiatric nurse practitioners, and licensed therapists working together to make a...


  • Melville, New York, United States Catholic Health Service Full time

    About Catholic HealthCatholic Health is a leading health and human services agency in Long Island, employing over 16,000 staff members across six acute care hospitals, three nursing homes, a home health service, hospice, and a network of physician practices.We prioritize compassionate care and evidence-based practice to deliver exceptional patient outcomes....


  • Melville, New York, United States Optum Full time

    About the PositionOptum is seeking a highly skilled Chief Neurological Specialist to join their team in Syosset, NY.Clinical Expertise and SupportYou will have access to the clinical resources and data of a global organization behind you, enabling you to provide exceptional patient care and help individuals live healthier lives.A Collaborative EnvironmentYou...


  • Melville, New York, United States Huntington Hills Center for Health & Rehabilitation Full time

    At Huntington Hills Center for Health & Rehabilitation, we are seeking a dedicated and compassionate Advanced Wound Care Specialist to join our team.About Us:Huntington Hills is a proud affiliate of National Health Care Associates, a family-run organization since 1984. We share common values: Kindness, Service, Compassion, and Excellence. Our centers provide...


  • Melville, New York, United States Optum Full time

    We are seeking an Endocrinologist to join our team in New York. As a clinician-led care organization, we are changing the way healthcare professionals work and live.OverviewOptum NY is a leading provider of medical services, offering a range of specialties and services across the care continuum. Our patient-centered approach focuses on providing high-quality...


  • Melville, New York, United States Crothall Healthcare Full time

    Job OverviewCrothall Healthcare, a leading provider of specialized healthcare support services, is seeking an experienced Electrical Equipment Specialist - Field Service Professional to join our team.This role offers a unique opportunity to work in a dynamic environment, providing critical maintenance and repair services to patient care equipment in...


  • Melville, New York, United States Optum Full time

    Immerse yourself in a dynamic environment as an Endocrinologist at Optum, where you'll be part of a team that's revolutionizing healthcare. We're seeking a skilled Endocrinologist to join our Syosset, NY clinic and contribute to our mission of making healthcare better for everyone. As a member of our interdisciplinary care team, you'll have the opportunity...

  • Mental Health Specialist

    60 minutes ago


    Melville, New York, United States LifeStance Health Full time

    Company Overview">LifeStance Health is a national provider of mental healthcare services focused on evidenced-based, medically driven treatment services for children, adolescents and adults suffering from a variety of mental health issues in an outpatient care setting.">About Us">We cultivate a space where everyone can show up as their authentic self. We...


  • Melville, New York, United States Huntington Hills Center for Health & Rehabilitation Full time

    Wound Care Nurse Opportunity at Huntington Hills Center for Health & RehabilitationWe are seeking a dedicated and compassionate Wound Care Nurse to join our team at Huntington Hills Center for Health & Rehabilitation. This is an exciting opportunity to make a meaningful difference in the lives of our residents and contribute to our commitment to delivering...


  • Melville, New York, United States QSAC, Inc. Full time

    Duties and ResponsibilitiesThis position involves:Maintaining contact with volunteer training sites and ensuring compliance with regulationsEnsuring the maintenance of agency vehicles and coordinating transportation for clientsReporting incidents, documenting events, and investigating causesLiaising with clinics providing speech and occupational...


  • Melville, New York, United States Optum Full time

    About Optum NYOptum is a leading care organization that empowers clinicians to deliver exceptional patient care. With a strong presence in the Tri-State region, we offer a dynamic work environment that fosters clinical innovation and transformation.Job Highlights• Endocrinologist position available in Syosset, NY• Independent practice with affiliation to...


  • Melville, New York, United States ALWAYS COMPASSIONATE HOMECARE LLC Full time

    About Our TeamWe are always looking for talented individuals to join our team at Always Compassionate Homecare LLC, a leading provider of community home-based services in New York.The Compassionate Care Enrollment Specialist will be responsible for educating prospective patients through the intake process, ensuring seamless enrollment with our company. This...


  • Melville, New York, United States Lloyd Staffing Full time

    About Lloyd StaffingLloyd Staffing is a leading staffing agency that connects professionals with top employers. We are committed to providing exceptional service and support to our clients and candidates.This role as Clinical Support Assistant is an exciting opportunity to join our team and contribute to the success of our clients.


  • Melville, New York, United States The Bachrach Group Full time

    Job OverviewThe Bachrach Group LTD. (TBG) is a national leader in both staffing and executive search, building better workforces with extraordinary talent based on specific functional experience.Salary Range$55,000 - $65,000 per annum, depending on qualifications and experience.Key ResponsibilitiesWe are seeking a detail-oriented Financial Clearance...


  • Melville, New York, United States ENT and Allergy Associates Full time

    We are seeking a licensed Audiologist Floater to join our team at ENT and Allergy Associates.This role is ideal for a self-motivated audiologist who is strong clinically and has excellent patient interaction skills.As a valued member of our practice, you will have opportunities for continuous training, coaching, and development, including paid CEU's.Your...