- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- CommonSpirit Health (Centennial, CO)
- …resources to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison ... external third-party payers to appeal denied claims and retrospectively identifies appeals determination as indicated through research and coordination of completion… more
- Mayo Clinic (Rochester, MN)
- …well as preparation of relevant appeal submission or audit responses. Utilizes clinical expertise and critical thinking in the evaluation of medical records against ... knowledge of ICD-10-CM/PCS coding conventions, DRG reimbursement methodology, and clinical validation principles, with demonstrated ability to interpret Coding… more
- Northwell Health (Melville, NY)
- …+ Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect ... retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness… more
- Nuvance Health (Danbury, CT)
- …critical part in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with CMS requirements, ... initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- Nuvance Health (Danbury, CT)
- …Hours 5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, ... and facilitates communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld cases in… more
- McLaren Health Care (Mount Pleasant, MI)
- …outcomes and fulfills the obligation and responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer ... + Certified Medical Coder, Certified in Healthcare Compliance, Certified Coding Specialist , or Certified Clinical Documentation Specialist certifications more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Coding Appeals Specialist analyzes patient medical records, claims data and coding on all ... Network Coding and CDMP Managers for education of the medical staff, clinical documentation professionals and the coding professionals on documentation issues that… more
- Ochsner Health (New Orleans, LA)
- …make a difference at Ochsner Health and discover your future today!** The Appeals Specialist is responsible for managing and resolving insurance claim denials ... decisions. The position requires strong analytical skills and collaboration with clinical and revenue cycle teams to optimize financial outcomes. **Education**… more
- Hartford HealthCare (Farmington, CT)
- …. Prepare, document, and submit appeals for DRG denials, ensuring appeals are well-supported with clinical evidence, coding guidelines, and regulatory ... Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS),and/or Certified Clinical Documentation Specialist … more
- University of Southern California (Arcadia, CA)
- …Documentation Improvement Practitioner (CDIP) certification status preferred. + Certified Clinical Documentation Specialist (CCDS) credential preferred. Pay ... for both formal and informal education for physicians, nursing, and other clinical staff. + Meets established productivity targets for record review and appropriate… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- Houston Methodist (Sugar Land, TX)
- …management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of care for ... and billing processes, managed care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of CPT and ICD… more
- Clark County, NV (Las Vegas, NV)
- YOUTH & ADULT INTERVENTION SPECIALIST I/II Print (https://www.governmentjobs.com/careers/clarkcounty/jobs/newprint/5146174) Apply YOUTH & ADULT INTERVENTION ... SPECIALIST I/II Salary $32.77 - $52.32 Hourly Location Clark...Vegas, NV Job Type PERMANENT Job Number 30433 Department Clinical Services Division Fam Clinic Svcs Opening Date 11/25/2025… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect revenue cycle support to the Revenue Cycle Managers. It is ... identified by the Revenue Cycle Managers. In addition, the Revenue Cycle Specialist is responsible for resolving all outstanding third-party primary and secondary… more
- University of Southern California (Alhambra, CA)
- …and claims submission. * Works cooperatively with HIM Coding Support and/or Clinical Documentation Improvement Specialist in obtaining documentation to complete ... compliance regulations and guidelines, the HIM Coding Denials Management Specialist " analyze, investigate, mitigate, and resolve all coding-related 'claims denials'… more
- State of Colorado (CO)
- CDOC Addiction Specialist II Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5123709) Apply CDOC Addiction Specialist II Salary $5,665.00 ... Number CAA Statewide D&A 11/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 11/03/2025 Closing Date 1/31/2026 4:00… more
- Globus Medical, Inc. (Collegeville, PA)
- …of exceptional response by partnering with researchers and educators to transform clinical insights into tangible solutions. Our solutions improve the techniques and ... Summary** **:** Reporting to the Supervisor, Patient Access, the Patient Access Specialist will focus on providing payer coverage support to customers from the… more
- State of Colorado (Canon City, CO)
- ADDICTION SPECIALIST I - Canon City Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5157619) Apply ADDICTION SPECIALIST I - Canon City ... Job Number CAA CMC 344 12/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 12/03/2025 Closing Date 12/17/2025 4:00… more
- US Tech Solutions (RI)
- …with other internal groups regarding determination status and results (seniors, pharmacists, appeals , etc). + Identify and elevate clinical inquiries to the ... **Job Title: Prior Authorization Specialist ** **Location: Fully remote** **Duration: 12 months contract**...timely and accurate documentation of reviews. + Transfers all clinical questions, escalations and judgement calls to the pharmacist… more