- BJC HealthCare (St. Louis, MO)
- …work experience) **Additional Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist with infusion appeals ... Responsible for resolving clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be able to multi-task and maintain a high… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- TEKsystems (San Bernardino, CA)
- Clinical Appeals Nurse - Revenue Cycle Management We are looking for a Clinical Appeals Nurse to join our Revenue Cycle Management team. In this role, ... and ability to interpret complex medical records. + Experience in clinical appeals , utilization review, or revenue cycle management. + Excellent attention to… more
- Northwell Health (Melville, NY)
- …+ Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect ... retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness… more
- Nuvance Health (Danbury, CT)
- …critical part in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with CMS requirements, ... initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- McLaren Health Care (Mount Pleasant, MI)
- …outcomes and fulfills the obligation and responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer ... + Certified Medical Coder, Certified in Healthcare Compliance, Certified Coding Specialist , or Certified Clinical Documentation Specialist certifications more
- Healthfirst (FL)
- …as: certain types of claim denials, member complaints, and member and provider appeals . The end-to-end process requires the Specialist to independently:** + ... within a framework that measures productivity and quality for each Specialist against expectations** + **Work independently exercising judgment starting the case… more
- University of Washington (Seattle, WA)
- …Medicine's Patient Financial Services Department** has an outstanding opportunity for a ** Clinical Appeals and Disputes Nurse.** **WORK SCHEDULE** + 100% FTE ... + 100% Remote + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ensures that payers are prepared to reimburse the UW Medicine for services… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Coding Appeals Specialist analyzes patient medical records, claims data and coding on all ... Network Coding and CDMP Managers for education of the medical staff, clinical documentation professionals and the coding professionals on documentation issues that… more
- Ochsner Health (New Orleans, LA)
- …make a difference at Ochsner Health and discover your future today!** The Appeals Specialist is responsible for managing and resolving insurance claim denials ... decisions. The position requires strong analytical skills and collaboration with clinical and revenue cycle teams to optimize financial outcomes. **Education**… more
- State of Colorado (Denver, CO)
- Certified Therapeutic Recreation Specialist (CTRS) - Clinical Therapist II Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5167891) Apply ... Certified Therapeutic Recreation Specialist (CTRS) - Clinical Therapist II Salary...if your application is eliminated. You will find the appeals process, the official appeal form, and how to… more
- University of Southern California (Arcadia, CA)
- …Documentation Improvement Practitioner (CDIP) certification status preferred. + Certified Clinical Documentation Specialist (CCDS) credential preferred. Pay ... for both formal and informal education for physicians, nursing, and other clinical staff. + Meets established productivity targets for record review and appropriate… more
- HCA Healthcare (Ocala, FL)
- **Description** **Introduction** Do you have the career opportunities as a Clinical Denial Coding Review Specialist you want with your current employer? We have ... are a committed, caring group of colleagues. Do you want to work as a Clinical Denial Coding Review Specialist where your passion for creating positive patient… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- Houston Methodist (Sugar Land, TX)
- …management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of care for ... and billing processes, managed care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of CPT and ICD… more
- CaroMont Health (Gastonia, NC)
- …and reporting. Perform data collection and analysis, trend identification for assigned clinical outcomes, and present this data at the appropriate meetings as ... promoting and monitoring safe, high-quality, cost-effective healthcare with the best clinical outcomes possible. Provide physician and nurse education to achieve… more
- University of Southern California (Alhambra, CA)
- …and claims submission. * Works cooperatively with HIM Coding Support and/or Clinical Documentation Improvement Specialist in obtaining documentation to complete ... compliance regulations and guidelines, the HIM Coding Denials Management Specialist " analyze, investigate, mitigate, and resolve all coding-related 'claims denials'… more
- State of Colorado (CO)
- CDOC Addiction Specialist II Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5123709) Apply CDOC Addiction Specialist II Salary $5,665.00 ... Number CAA Statewide D&A 11/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 11/03/2025 Closing Date 1/31/2026 4:00… more
- Globus Medical, Inc. (Collegeville, PA)
- …of exceptional response by partnering with researchers and educators to transform clinical insights into tangible solutions. Our solutions improve the techniques and ... Summary** **:** Reporting to the Supervisor, Patient Access, the Patient Access Specialist will focus on providing payer coverage support to customers from the… more
- US Tech Solutions (RI)
- …with other internal groups regarding determination status and results (seniors, pharmacists, appeals , etc). + Identify and elevate clinical inquiries to the ... **Job Title: Prior Authorization Specialist ** **Location: Fully remote** **Duration: 12 months contract**...timely and accurate documentation of reviews. + Transfers all clinical questions, escalations and judgement calls to the pharmacist… more