- R1 RCM (Detroit, MI)
- …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
- Molina Healthcare (Provo, UT)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...pharmacy, etc.). + Experience demonstrating knowledge of ICD-9, CPT coding and HCPC. + Experience demonstrating knowledge of CMS… more
- City and County of San Francisco (San Francisco, CA)
- … documentation reflects the appropriate level of service. + Utilizes both clinical and coding knowledge effectively. + Performs initial inpatient chart ... EXPERIENCE: At least one (1) year of experience working as a Registered Nurse SPECIALTY REQUIREMENTS: + Clinical Documentation Specialist (CCDS) certification +… more
- Independent Health (Buffalo, NY)
- …Collaborative and Accountable. **Essential Accountabilities** + Thoroughly investigate clinical appeals and complaints/grievances utilizing appropriate internal ... support of a high performing health plan and physician network. The Clinical Reviewer will investigate quality complaints/grievances and appeals , document… 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
- 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
- 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
- Sharp HealthCare (San Diego, CA)
- …0 **Shift Start Time** **Shift End Time** Other; California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians **Hours** ... care. **Required Qualifications** + Other : Graduate of an accredited Licensed Vocational Nurse (LVN) program. + California Licensed Vocational Nurse (LVN) - CA… 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
- Elderwood (Waverly, NY)
- Salary $38 - $53.30 / 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
- ManpowerGroup (Columbia, SC)
- **Utilization Management Nurse / Social Worker (Contract Position)** **Location:** Remote (Must Train Onsite for 1-2 Weeks) - Must Reside Within 3 Hours of Client ... Format:** Microsoft Teams **Job Overview** We are seeking a **Utilization Management Nurse or Licensed Social Worker** to perform medical reviews and utilization… more
- Ascension Health (Cedar Park, TX)
- …cases. + Assist departmental staff with issues related to coding , medical records/documentation, precertification, reimbursement and claim denials/ appeals . ... and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Texas Board of Nursing or current home… more