- Molina Healthcare (Midvale, UT)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... _For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...with internet connectivity of high speed required._ **Job Summary** Clinical Appeals is responsible for making appropriate… more
- St. Luke's University Health Network (Allentown, PA)
- …and/or formal meetings with auditor or payor representatives in defense of coding appeals , as needed. + Maintain necessary audit/appeal activity documents ... patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient...and CDMP Managers for education of the medical staff, clinical documentation professionals and the coding professionals… more
- Virtua Health (Mount Laurel, NJ)
- …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... between 7am- 7pm depending on meetings with clinicians. Summary: Responsible for coding quality and audits, education and training, etc. for ICD-10-CM, CPT and… more
- Trinity Health (Hartford, CT)
- …Type:** Full time **Shift:** Day Shift **Description:** **Position Purpose** The Clinical Pre-Service Nurse Coordinator is directly responsible for reviewing ... trends to remediate issues and assist with internal process improvement. Leverages clinical knowledge and standard procedures to ensure timely attention to denials… more
- US Tech Solutions (Columbia, SC)
- …+ NICE TO HAVE skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral Health or infusion therapy ... line of business. Previous Medicare experience and /or UR experience/Process Appeals requests/can have experience in either Utilization management or Appeals… 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
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a **Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale AFB, ... accordance with References (e) and (o). After following the directed methodology for appeals , the MTF will also adhere to its respective Service or joint commands'… more
- Hartford HealthCare (Farmington, CT)
- …Coding management for discussion and plans for dissemination to providers, clinical documentation specialists (CDS), and coding professionals. . Facilitates ... other specialty reviews. This position also supports denials and appeals specialists as a subject matter expert (SME) and...coding professionals. . Presents on topics related to clinical documentation integrity in all care settings to all… 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
- Trinity Health (Livonia, MI)
- …a demonstrated knowledge of clinical processes, charge master maintenance, clinical coding (CPT, ICD-10, revenue codes and modifiers), charging processes ... _CHRI_ certification/membership _strongly_ preferred. Must possess a demonstrated knowledge of clinical processes, clinical coding (CPT, HCPCS, ICD-9/10,… 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
- Beth Israel Lahey Health (Burlington, MA)
- …& Appeals , Patient Access, Authorization Management & review, HIM, Coding & Billing. Close collaboration with the Physician Advisors, Collaborates and helps ... and reviews staff schedules and workflows and works closely with other administrative and clinical areas under the direction of the Executive Director and the VP of… more
- UNC Health Care (Chapel Hill, NC)
- …focus include Surgery, Women's, and Children's at UNCMC. The team: + Completes clinical reviews for all areas: pediatric, adult surgical, and postpartum patients + ... revenue by working with payors for insurance authorizations, denials, and appeals + Delivers mandated federal notices to patients/ patient representatives related… more
- CareFirst (Baltimore, MD)
- …authorization of services and approved claims. + Prepares retrospective reviews, case appeals , billing coordination, and clinical support. + Manages the analysis ... hiring methods to meet departmental needs. We are looking for an experienced clinical leader in the greater Baltimore metropolitan area who is willing and able… more
- Elderwood (Liverpool, NY)
- Salary $38.00 - $49.50 / 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
- Stony Brook University (Stony Brook, NY)
- …a **Case Manager** is a valuable member of our team, who provides clinical services to our patient population. Qualified candidates will demonstrate superior patient ... the hospital stay. + Assist with coverage for UR, Appeals and denials + Actively involved in performance improvement...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN license… more