- 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
- 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 account… more
- CVS Health (Hartford, CT)
- …position are Monday-Friday 8a-5p in time zone of residence. 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
- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you want to join an organization that invests in you as a Clinical Appeals Team Lead? At Parallon, you come first. HCA Healthcare has ... make a difference. We are looking for a dedicated Clinical Appeals Team Lead like you to...and contacting insurance companies to resolve claims denied for clinical reason. + Identifies coding or … more
- CVS Health (Hartford, CT)
- …residence with occasional rotational weekend and holiday coverage. Position Summary The Appeals Nurse Consultant position is responsible for processing the ... in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates...licensure in state of residence + 3+ years of clinical experience Preferred Qualifications + Coding experience… 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
- Rush Copley Medical Center (Aurora, IL)
- …The Appeals Specialist RN reviews inpatient hospital denials, clinical validation requests, and upheld denials after physician-to-physician (P2P) discussions ... then conducts appeals , as appropriate. Monitors and tracks denial outcomes with...insurance companies and revenue cycle leadership to prevent future clinical denials by communicating denial root causes and help… 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
- Virtua Health (Marlton, 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
- Martin's Point Health Care (Portland, ME)
- …services requiring clinical review prior to payment. The Utilization Review Nurse will use appropriate governmental policies as well as specified clinical ... , and other compliance, or reimbursement related issues. Responsible for leveraging clinical and/or coding experience to perform facility and provider medical… 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
- 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 ... + Ensure accuracy of all sections of Multiple Data Set (MDS) coding to maximize company reimbursement consistent with the levels of treatment delivered… 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
- Stanford Health Care (Palo Alto, CA)
- …medical necessity. + Stay current with regulatory policies and guidelines related to clinical appeals . + Apply regulatory knowledge to strengthen appeal cases. + ... Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN) will be responsible for ensuring the efficient and effective… 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
- 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
- Virtua Health (Berlin, NJ)
- …billing process.* Maintains open communication with management regarding billing and coding issues including documentation, denials/ appeals , etc.* Follows up on ... over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques… more
- UNC Health Care (Chapel Hill, NC)
- …the unique communities we serve. RN Utilization Manager position specifically for a Utilization Manager/ Clinical Appeals Nurse . This person is based at the ... Hedrick building and is 100% on-site. This individual combines clinical , business, and regulatory knowledge to reduce significant financial risk caused by concurrent… more