- McLaren Health Care (Grand Blanc, MI)
- …duties as required and directed. **Qualifications:** _Required_ + State licensure as a registered nurse (RN) + Bachelor's degree in nursing from accredited ... with physicians, other team members, payers, and administrators regarding denial and appeals cases reviews and process....or utilization review experience + Five years of clinical nurse experience in an acute care setting + American… more
- McLaren Health Care (Mount Clemens, MI)
- …auditors . Provides support to both internal and external customers for denial / appeals activities and audits. Assists with monitoring and auditing activities, ... requests for medical record documentation and the filing of responses and appeals . 1. Appropriately documents denial /appeal activities; oversees and documents… more
- BronxCare Health System (Bronx, NY)
- …special projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate ... the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to… more
- McLaren Health Care (Grand Blanc, MI)
- …**_Required:_** + Associate's degree in nursing or healthcare related field **.** Current Registered Nurse license in the state of Michigan or possess a ... practice standards. 5. Assists with managing the revenue cycle by reducing clinical denial write offs 6. Assists in running reports and utilizes tools for reporting… more
- Beth Israel Lahey Health (Plymouth, MA)
- …+ Collaborates with the multidisciplinary team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR ... Manager and/or physician advisor regarding cases that do not meet established guidelines for admission or continued stay. + Acts as a liaison between physicians and payers, coordinating peer-to-peer phone calls. + Collects and compiles data as required. _It is… more
- Molina Healthcare (Warren, MI)
- …will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing clinical knowledge and ... and audit details in the database + Provides supporting documentation for denial and modification of payment decisions + Independently re-evaluates medical claims… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- …duties as assigned. + LICENSES AND/OR CERTIFICATIONS + Current Virginia state license as a Registered Nurse or Registered Nurse holding a valid Compact ... + 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
- Houston Methodist (Sugar Land, TX)
- …and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure - Must ... is responsible for performing utilization review activities, and monitoring the clinical denial management and appeals process, as applicable, in collaboration… more
- Nuvance Health (Danbury, CT)
- …in nursing, health administration, or a related field preferred * Current licensure as a registered nurse (RN) * Minimum of 5 years of clinical experience in an ... lengths of stay, enhanced organizational efficiency, and maximized reimbursement through denial reduction and successful appeals . The *System Care Coordination… more
- Arnot Health (Elmira, NY)
- …denial errors, types and recurring issues. 4. Facilitates, coordinates and prepares denial appeals working with internal and external customers in a proactive ... Auth/ Denial Management meetings EDUCATION: RN required. EXPERIENCE: NYS licensed Registered Nurse required. Bachelor's in nursing preferred. Must have… more
- Fairview Health Services (St. Paul, MN)
- …denial reports and other statistical reports. + Collaborates with Clinical Denials Nurse Specialist and Leadership in high-dollar claim denial review and ... analyzes medical records and coding guidelines to formulate coding arguments for appeals and/or coding guidance for potential re-bills. Maintains a working knowledge… more
- UHS (Binghamton, NY)
- …(5) years of experience in acute/tertiary facility. + Minimum Required: NYS Licensed Registered Nurse Preferred: + Bachelor's of Science in Nursing with three ... the prevention and resolution of clinical claim denials by analyzing denial patterns, investigating and appealing denied claims, and collaborating across departments… more
- HCA Healthcare (Las Vegas, NV)
- …appeals , denials, managed care contracting, experienced preferred. + Currently licensed as a registered nurse (RN) in the state(s) of practice and/or has an ... in accordance with policies and procedures. Escalate medical review request and /or denial activities to management as needed. **What you will do in this role:**… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. ... Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient advocate between Dana… more
- Children's Mercy Kansas City (Kansas City, MO)
- …and Performance Improvement Leadership + One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire + One of the ... practice in patient status recommendations, medical necessity review, pre-bill denial avoidance and denial management. + Partners...following: Licensed RN - Kansas, Registered Nurse Multistate License Kansas required upon… more
- Ellis Medicine (Schenectady, NY)
- …and assist in utilization management activities under the direction of a registered nurse and/or social worker. Responsibilities include maintaining case files, ... primary function is to work with the Social Worker, Nurse Case Manager, or Utilization Management Nurse ...or send for insurance denials or quality improvement organization appeals . + Assists UM Coordinator with data entry of… more
- WesleyLife (Urbandale, IA)
- …Case Managers. + Complete additional development request (ADR) reviews and insurance denial appeals . + Perform admissions, client visits, and supervisory visits. ... **Required** + Car Insurance + Driver's License + Basic Life Support + Registered Nurse **Experience** **Required** + 2 years: Full-time work experience as a … more
- Alameda Health System (Oakland, CA)
- …nursing background. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. Preferred ... denied cases when necessary and assists physicians with appeals . Maintains minimal denial rates by Medicare, MediCal, private and contracted payers through… more
- Highmark Health (Pittsburgh, PA)
- **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care and manages ... contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials/ appeals and retrospective payer audit denials. Collaboratively formulates plans… more
- Alameda Health System (San Leandro, CA)
- …TAR and other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic ... Heart Association. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. **PAY RANGE** $58.74 - $97.91… more