- R1 RCM (Detroit, MI)
- …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
- R1 RCM (Salt Lake City, UT)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Supervisor** , you will ... guidelines. **Here's what you will experience working as a Clinical Coding Appeals Supervisor:** +...on a routine basis. **Required Skills:** + Active Registered Nurse license + Active AHIMA or AAPC Coding… more
- HCA Healthcare (Brentwood, TN)
- **Description** **Introduction** Do you have the career opportunities as a Clinical Appeals Nurse RN you want with your current employer? We have an exciting ... of colleagues. Do you want to work as a Clinical Appeals Nurse RN where...root cause of each denial and apply company specific coding for trending and analysis. + Update the patient… more
- Molina Healthcare (Columbus, OH)
- …(occasional weekend per business need) Unrestricted RN licensure **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical ... **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
- Molina Healthcare (Columbus, OH)
- …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
- Catholic Health (Buffalo, NY)
- …care team on an ongoing basis in relation to trends in denials, and clinical documentation. Responsible for working alongside coding , clinical documentation ... potential Summary: This position is accountable for carrying out and documenting the appeals process for denied claims denied due to reasons including, but not… 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
- Intermountain Health (Columbus, OH)
- **Job Description:** The Manager, RN Revenue Integrity Audit, Recovery and Appeals organizes and manages the daily operations of the Audit and Recovery teams in the ... recoupment efforts. Additionally, the Manager will support coordinating efforts on clinical denials for medical necessity when needed and collaborate with external… more
- Centene Corporation (Austin, TX)
- … coding / clinical decisions on first time claims, adjustments and appeals in accordance with correct coding guidelines and Centene payment policies. ... by performing medical claim reviews to ensure compliance with coding guidelines through a comprehensive review and analysis of...a managed care organization preferred LPN - Licensed Practical Nurse - State Licensure required or RN - Registered… more
- Molina Healthcare (Everett, WA)
- …supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous claims and appeals experience. The candidate must have ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical … 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
- 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
- US Tech Solutions (Columbia, SC)
- …reviewing appeals , post-service experience highly preferred. Background with billing and coding or claims review. Broad clinical background + A typical day ... This is a production role reviewing provider reconsideration cases, approving at the nurse level when possible and sending cases to a medical director as needed.… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …Medicaid Services (CMS) and other sources. + Liaise with Utilization Management and Clinical Appeals Departments to regularly review data from same specialty and ... (Required) + Registered Nurse , Physician's Assistant, or Nurse Practitioner with five (5) years' clinical ...of the following: pre-service review, post services review, and/or clinical appeals . (Required) + Superior clinical… more
- Corewell Health (Southfield, MI)
- …audits and appeals . + Educates members of the healthcare team about clinical documentation guidelines, coding and quality measures via 1:1 rounding, unit ... with providers to ensure overall specificity, accuracy and completeness of clinical documentation to support the highest integrity of the medical record.… more
- University of Washington (Seattle, WA)
- …records coding staff, patient financial services (PFS) and compliance for Clinical Validation Denial appeals . **REQUIREMENTS** Please apply only if you meet ... Req #: 244821 Department: UW MEDICAL CENTER - CLINICAL DOCUMENTATION Posting Date: 04/21/2025 Closing Info: Open...in an acute inpatient hospital setting as a registered nurse , with in-depth knowledge of medical and surgical care.… 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
- Peak Vista (Colorado Springs, CO)
- …for understanding clinical documentation and how it relates to medical coding , coding guidelines and payer rules. Essential Duties and Responsibilities ... exceptional health care to people facing access barriers through clinical programs and education. We provide integrated health care...+ Provides expertise to Accounts Receivable Staff in addressing appeals for denials due to potential coding … more
- Sharp HealthCare (San Diego, CA)
- …Day **FTE** 0 **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) - CA… more
- Elderwood (Waverly, NY)
- Salary $38 - $53.30 / hourly 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