- 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
- CVS Health (Hartford, CT)
- …Basic awareness of problem solving and decision making skills Position Summary The Appeals Nurse Consultant position is responsible for processing the medical ... independently as well as in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates 7 days per week, 365… more
- Universal Health Services (Richmond, VA)
- …https://uhs.com/ The Atlantic Region CBO is seeking a dynamic and talented Clinical Documentation Improvement (CDI) Nurse . The Clinical Documentation ... in this position + At least 5 years of clinical experience in an acute care setting + CCDS...criteria + Working knowledge of Medicare reimbursement system and coding structures preferred + Assertive personality traits to facilitate… more
- Trinity Health (Farmington Hills, MI)
- …timeliest manner possible: + Coordinates follow-up activities with Utilization Review/Case Management/ Coding / Nurse Liaison to provide required clinical ... location. The scope of responsibility will be all post-billed denials (inclusive of clinical denials). Serves as part of the Payment Resolution team at an assigned… more
- Trinity Health (Farmington Hills, MI)
- …timeliest manner possible: + Coordinates follow-up activities with Utilization Review/Case Management/ Coding / Nurse Liaison to provide required clinical ... of responsibility will be all post-billed denials (inclusive of clinical denials). Serves as part of a team of...state/federal laws as they relate to contracts and the appeals process. Assists in training Payment Resolution Specialist I… more
- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview The Clinical Coding and Audit Specialist monitors, responds and performs the clinical coding and audit ... position will also support detailed level reporting and analytics, clinical appeals , root cause analysis, and address...a current license/registration by state of hire as a nurse + Successfully completed HCS-D coding certification,… more
- ERP International (Tinker AFB, OK)
- …according to appropriate health plan. If unsure, coordinates with TRICARE Regional Office Clinical Liaison Nurse or reviews TRICARE Operations Manual. * Receives ... Records, Patient Administration, Group Practice Managers, Health Care Integrators, Coders/ Coding Auditors, Population Health Nurse Consultants, Medical… more
- The Cigna Group (Bloomfield, CT)
- …+ Experience with Medicare Advantage clinical reviews for claims, disputes, or appeals . + Experience with DRG coding . + This position requires at least ... . **Major Job Responsibilities** + Responsible for leveraging clinical and/or coding experience and perform facility and provider medical record reviews in… more
- EM Key Solutions, Inc. (Eglin AFB, FL)
- …according to appropriate health plan. If unsure, coordinates with TRICARE Regional Office Clinical Liaison Nurse or reviews TRICARE Operations Manual. + Receives ... Records, Patient Administration, Group Practice Managers, Health Care Integrators, Coders/ Coding Auditors, Population Health Nurse Consultants, Medical… more
- EM Key Solutions, Inc. (Eglin AFB, FL)
- …to the appropriate health plan. If unsure, coordinates with TRICARE Regional Office Clinical Liaison Nurse or reviews TRICARE Operations Manual. + Receives and ... Records, Patient Administration, Group Practice Managers, Health Care Integrators, Coders/ Coding Auditors, Population Health Nurse Consultants, Medical… more
- Banner Health (AZ)
- …1. Provides clinical expertise and oversight in the determination of the clinical appeals and denial management process resulting in significant savings for ... you're looking to leverage your abilities - apply today. The Registered Nurse RN Denial Management Specialist is responsible for reviewing concurrent inpatient… more
- Trinity Health (Newtown, PA)
- …with Patient Business Service (PBS) center and ensures compliant and complete clinical documentation, assists with denials and related appeals , and identifies ... patient status, length of stay, level of care, missing pre-certification, or other clinical reasons and constructing warranted appeals for defined populations. +… 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
- Centers Plan for Healthy Living (Brooklyn, NY)
- …+ Strong communication skills. + Building relationships + Working knowledge of clinical documentation requirements & Medicare Risk Adjustment coding Preferred: ... Nurse Practitioner - ISNP (Full-Time) Brooklyn, NY, USA...Reviews and manages pharmacotherapy of each member, collaborating with clinical pharmacist and physicians when necessary. + Prescribe appropriate… 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
- Ascension Health (Nashville, TN)
- …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
- 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 + 3 Years experience in the acute patient care and/or… more
- Universal Health Services (Edinburg, TX)
- …intensity of care, and risk of mortality. Responsible for internal audits, appeals , research on coding guidelines and/or regulations. Communicates with Regional ... Responsibilities POSITION SUMMARY: The Compliance Auditor - Clinical Documentation Integrity (CDI) is responsible for improving...CDI Manager, Regional Coding Manager, Supervisors and HIM management to accomplish hospital's… more
- Marshfield Clinic (Marshfield, WI)
- …**Job Title:** Reimbursement Educator (Remote in Wisconsin) **Cost Center:** 101651059 Coding -Audit Appeals Educ **Scheduled Weekly Hours:** 40 **Employee ... a Registered Nurse , license awarded by the State of Wisconsin. Coding certification within three years of hire. **Preferred/Optional:** Current coding … more
- Sutter Health (Berkeley, CA)
- …start and continuity of services. Works in conjunction with managed care and coding departments to maintain accuracy in clinical and billing information. **Job ... Enters supporting data into comment box. Communicates with supervisor or charge nurse , physicians, practice staff when there are issues with authorization. ONCOLOGY:… more