- R1 RCM (Boise, ID)
- …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
- LA Care Health Plan (Los Angeles, CA)
- …with Registered Nurses and Medical Directors to appropriately investigate, review and resolve clinical appeals and grievances. Prepares Nurse Summary for MD ... Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical...of resolution letters. Reviews grievance cases that require immediate clinical quality of care, initial coding of… more
- CDPHP (Albany, NY)
- …share these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and ... Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations… more
- MetroHealth (Cleveland, OH)
- …departments and more than 20 health centers.** **Summary:** **Performs secondary clinical chart reviews, resolves DRG discrepancies, and educates clinical ... opportunities to improve documentation accuracy. Reviews DRG downgrades and strategic CDI appeals , and responds to payor audits and inpatient downgrade requests when… more
- Trinity Health (Albany, NY)
- …with Patient Business Service (PBS) center and ensures compliant and complete clinical documentation, assists with denials and related appeals , and identifies ... Type:** Full time **Shift:** Day Shift **Description:** **Revenue Integrity Nurse Auditor - Remote - St. Peter's Hospital -...of stay, level of care, missing pre-certification, or other clinical reasons and constructing warranted appeals for… 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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …encompasses a member and provider call center, provider correspondence and appeals , clinical review, member correspondence and reconsiderations, enrollment, ... clinical (RN) reviewers and offers guidance on clinical and coding integrity reviews that are...required. Bachelor's degree preferred + Experience with the Provider appeals process required; coding and claims knowledge… 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
- Stanford Health Care (Palo Alto, CA)
- …medical necessity. + Stay current with regulatory policies and guidelines related to clinical appeals . + Apply regulatory knowledge to strengthen appeal cases. + ... Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN) will be responsible for ensuring the efficient and effective… 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
- ERP International (Nellis AFB, NV)
- …admissions, including all eligible beneficiaries, to civilian hospitals and notifies Clinical Nurse Case Manager and Patient Administration Element as ... **Overview** ERP International is seeking **Registered Nurse (RN) Utilization Managers** for full-time positions in support of theMike O'Callaghan Military Medical… more
- Cleveland Clinic (Vero Beach, FL)
- …information to the payer, UM data collection and reporting, concurrent denials appeals process, clinical team interaction, Physician Adviser interaction and ... information to payers, UM data collection and reporting, concurrent denials appeals process, clinical team interaction, Physician Adviser interaction and… 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
- US Tech Solutions (Columbia, SC)
- …and appeals . Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. ... we review the requests against the policy and the member's contract. When reviewing the clinical we determine if it can be reviewed at our level. If not, then it… 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 (Waverly, NY)
- Salary $36.00 - $52.00 Overview Are you a Registered Nurse (RN) with Medicare experience? Do you consider yourself an expert in assessment and reimbursement ... 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
- Ascension Health (Austin, TX)
- …Review medical records to determine accuracy of billing through verification of coding , billing and supporting clinical documentation. + Coordinate all activity ... Talent Advisor for additional specifics._ **Responsibilities** Coordinate payer denials and appeals , respond to insurance company requests for medical records, and… more
- Ascension Health (Glendale, WI)
- …Review medical records to determine accuracy of billing through verification of coding , billing and supporting clinical documentation. + Coordinate all ... Talent Advisor for additional specifics._ **Responsibilities** Coordinate payer denials and appeals , respond to insurance company requests for medical records, and… more