- Monster (Allentown, PA)
- …appeal process. Assists billing staff regarding outpatient denials for experimental, coding or other issues that may require record review. Provides billing ... commercial insurance rejections, denials for possible experimental services and coding issues, providing supplemental information to resolve claim. Identifies… more
- Molina Healthcare (Omaha, NE)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...pharmacy, etc.). + Experience demonstrating knowledge of ICD-9, CPT coding and HCPC. + Experience demonstrating knowledge of CMS… more
- CVS Health (Hartford, CT)
- …business hours 8a-5p in time zone of residence Monday - Friday. The Appeals Nurse Consultant position is responsible for processing the medical necessity ... Qualifications** + Managed Care experience + Utilization Management experience + Coding experience + Appeals experience **Education** + Associate's Degree… more
- CVS Health (Columbus, OH)
- …support cost-effective quality care for members. Administers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical ... regulatory and accreditation requirements for members and providers. Coordinates clinical resolutions with internal and external support areas. **Required… more
- Henry Ford Health System (Troy, MI)
- …GENERAL SUMMARY: Unit Description: Health Alliance Plan (HAP) is looking to grow our Medical Appeals Team with an experienced Registered Nurse ! We are a team of ... RN PROVIDER APPEALS COORDINATOR - MEDICAL APPEALS -...+ Minimum of two (2) years of experience in clinical management of patients in an inpatient or ambulatory… more
- Virtua Health (Mount Laurel, NJ)
- …Coding Audit Response: Conducts Trains new coders to utilize the medical record, clinical , coding and abstracting systems, in conjunction with UHDDS and other ... over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques… more
- Fairview Health Services (St. Paul, MN)
- …Reviews and analyzes medical records and coding guidelines to formulate coding arguments for appeals and/or coding guidance for potential ... critical research and timely and accurate actions including preparing and submitting appropriate appeals or re-billing of claims to resolve coding denials to… more
- Molina Healthcare (Warren, MI)
- …for a RN with experience with appeals , claims review, and medical coding . **Job Summary** Utilizing clinical knowledge and experience, responsible for review ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical … 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
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a **Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale AFB, ... accordance with References (e) and (o). After following the directed methodology for appeals , the MTF will also adhere to its respective Service or joint commands'… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Staff Nurse *to join our Utilization Management department in a*/*FLOAT*/*/assignment to support Inpatient, Psych and the ... Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical necessity, appropriateness,… more
- Garnet Health (Middletown, NY)
- …Garnet Health Medical Center. Responsibilities Under the direction of The Administrator, Coding & Clinical Documentation Improvement and Patient Access, the ... other clinical professional staff. * Knowledge of DRG and Coding appeal process Required Certification/Registration: * Certified Clinical Documentation… more
- UHS (Binghamton, NY)
- Position OverviewUnited Health Services (UHS) is seeking a proactive and analytical Clinical Denials Specialist to join our Revenue Cycle team. In this vital role, ... you will focus on the prevention and resolution of clinical claim denials by analyzing denial patterns, investigating and appealing denied claims, and collaborating… 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
- Trinity Health (Livonia, MI)
- …a demonstrated knowledge of clinical processes, charge master maintenance, clinical coding (CPT, ICD-10, revenue codes and modifiers), charging processes ... . CHRI certification/membership strongly preferred. Must possess a demonstrated knowledge of clinical processes, clinical coding (CPT, HCPCS, ICD-9/10,… 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. ... internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines. Responds… more
- CareFirst (Baltimore, MD)
- …authorization of services and approved claims. + Prepares retrospective reviews, case appeals , billing coordination, and clinical support. + Manages the analysis ... hiring methods to meet departmental needs. We are looking for an experienced clinical leader in the greater Baltimore metropolitan area who is willing and able… more
