- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …It encompasses a member and provider call center, provider correspondence and appeals , clinical review , member correspondence and reconsiderations, ... Summary: The RN Clinical Provider Post Service Review Manager , led by a Registered Nurse...associates who research and respond to provider inquires and appeals , build cases, and perform claim adjustments in a… more
- Sedgwick (Boston, MA)
- … review experience in multi-state jurisdiction; prior experience in PPO provider appeals , re-pricing, surgery review , by report and RNE review ; ... and/or technical bills. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Applies clinical editing. + Reviews operative reports to determine if...two (2) years of experience in daily application of nurse auditing, utilization review and bill … more
- Brockton Hospital (Brockton, MA)
- …external review agencies, to coordinate activities involved in medical record review , denials, appeals and reconsideration hearings. Works closely with the ... include the development and supervision of staff (RNs, LPN's,SWs and non- clinical support), evaluation and maintenance of case management skills and outcomes,… more