- R1 RCM (Salt Lake City, UT)
- …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you ... this remote production-drive position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical… more
- Northwell Health (Melville, NY)
- …stay. Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately ... as a resource for the Health System. Reviews denial trends and identifies coding issues and knowledge gaps. Job Responsibility Serves as liaison between the patient… more
- CVS Health (Hartford, CT)
- …zone of residence. **Position Summary** Responsible for the review and resolution of clinical appeals . Reviews documentation and interprets data obtained from ... support as required. This position may support UM, MPO, Coding , or Behavioral Health appeals . **Required Qualifications**...RN licensure in state of residence + 3+ years clinical experience **Preferred Qualifications** + Appeals Experience… more
- CVS Health (Frankfort, KY)
- … coverage, and policies. Responsible for the review and resolution of clinical complaints/grievances and appeals . Interprets data obtained from clinical ... RN, MD, etc.). Commands a comprehensive knowledge of complex delegation arrangements, coding logic, contracts (member and provider), clinical criteria, benefit… more
- St. Luke's University Health Network (Allentown, PA)
- …appeal process. Assists billing staff regarding outpatient denials for experimental, coding or other issues that may require record review. Provides billing ... and commercial insurance rejections, denials for possible experimental services and coding issues, providing supplemental information to resolve claim. + Identifies… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- …defense, LifeNet and special focus audits and reports findings. + Serves as a clinical resource for coding / denial management and customer service issues. + ... + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and...supporting documentation, as well as facilitates the completion of appeals in a timely manner. + Prepares trend and… more
- UNC Health Care (Goldsboro, NC)
- …the Physician Advisors and subject matter experts for all audit and appeals work activities. Responsibilities: 1. Provides leadership, clinical expertise and ... denials for validity and probability to overturn, proactively gathers required clinical documentation and formulates appropriate appeals . Coordinates the denial… more
- Wesley Enhanced Living (Philadelphia, PA)
- …as a Best Workplace in our industry! Hiring Immediately! The Registered Nurse Assessment Coordinator (RNAC) provides for the initial assessment and periodic ... implement and update resident Plan of Care. The Registered Nurse Assessment Coordinator (RNAC) would: + Ensure accuracy of...accuracy of all sections of Multiple Data Set (MDS) coding to maximize company reimbursement consistent with the levels… more
- MaineGeneral Health (Waterville, ME)
- …initiatives. Assists departmental staff with issues related to coding , medical records/documentation, pre-certifications, reimbursement and claim denials/ appeals ... patients and their families. MaineGeneral Hospice is currently seeking an experienced Registered Nurse (RN) for a 32-40 hour per week position. The Hospice Quality… more
- Nuvance Health (Danbury, CT)
- …and operational oversight for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while partnering with local case ... appeals specialists to meticulously investigate denied claims, prepare comprehensive appeals , and collaborate with clinical staff to ensure successful… more
- Eastern Connecticut Health Network (Vernon, CT)
- Why consider applying to Visiting Nurse & Health Services of CT? Here are a few reasons: - Small territories and manageable caseloads for a better work-life balance. ... and initiatives for improvement in areas identified such as correct coding and documentation initiatives, infection control program and records management. Quality… more
- Apex Health Solutions (Houston, TX)
- …carrying out day today pre-authorization functions. The Utilization Review Nurse will also be responsible for issuing pre-authorization approvals/denials, notifying ... prospective review/precertification requirements. Collects and/or documents all required enrollee clinical and co-morbidity information during the pre-authorization process to… more
- Sutter Health (San Mateo, CA)
- …start and continuity of services. Works in conjunction with managed care and coding departments to maintain accuracy in clinical and billing information. **Job ... Enters supporting data into comment box. Communicates with supervisor or charge nurse , physicians, practice staff when there are issues with authorization. ONCOLOGY:… more
- Sharp HealthCare (San Diego, CA)
- …Day **FTE** 1 **Shift Start Time** **Shift End Time** California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians; Other ... care.** **Required Qualifications** + Other : Graduate of an accredited Licensed Vocational Nurse (LVN) program. + California Licensed Vocational Nurse (LVN) -… more
- Cleveland Clinic (Cleveland, OH)
- …documentation improvement opportunities to assist with appeal defense process. + RAC/Payer Audit Nurse : + Support denials and appeals within the Payer Audit ... A caregiver who excels in this role will: + Payer Denial Management Nurse : + Support the denial and appeal process within the Payer Denial Management… more
- UNC Health Care (Chapel Hill, NC)
- …focus include Surgery, Women's, and Children's at UNCMC. The team: + Completes clinical reviews for all areas: pediatric, adult surgical, and postpartum patients + ... revenue by working with payors for insurance authorizations, denials, and appeals + Delivers mandated federal notices to patients/ patient representatives related… more
- CareFirst (Baltimore, MD)
- …authorization of services and approved claims. + Oversees retrospective reviews, case appeals , billing coordination, and clinical support. + Ensure that staff ... **Resp & Qualifications** **PURPOSE:** We are looking for an experienced clinical leader in the greater Baltimore metropolitan area who is willing and able to work… more
- Elderwood (Wheatfield, NY)
- …days and activities to celebrate holidays, game days, etc. Are you a Registered Nurse (RN) with Medicare experience? Do you consider yourself an expert in assessment ... of Benefits Program + Increased Tuition Reimbursement Program for Clinical Tracks + Shift Differentials + Full Benefits Package...for pre and post-pay record reviews, ADR requests and appeals processes. + Manages NYS RUGs III case mix… more