- Molina Healthcare (Salt Lake City, UT)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that ... regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and… 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
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview: ;** The Clinical Appeals Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory ... a case for determination, interacting directly with providers to obtain additional clinical information, and with members or their advocates to understand the full… 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
- Stanford Health Care (Palo Alto, CA)
- …Government Audit Analyst and Appeals Specialist II will collaborate with clinical staff, coding professionals, and external stakeholders to ensure timely and ... role in the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials. This position… 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
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Staff Nurse *to join our Utilization Management department for the/Emergency Department / This position is a*0.6 FTE (6 ... Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical necessity, appropriateness,… more
- Garnet Health (Middletown, NY)
- …Garnet Health Medical Center. Responsibilities Under the direction of The Administrator, Coding & Clinical Documentation Improvement and Patient Access, the ... knowledge, required* Exceptional ability to communicate effectively with physicians and other clinical professional staff.* Knowledge of DRG and Coding appeal… more
- US Tech Solutions (Columbia, SC)
- …management of professional, inpatient or outpatient, facility benefits or services, and appeals . + Documents decisions using indicated protocol sets or clinical ... internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines. +… more
- Sharp HealthCare (San Diego, CA)
- …of the Revenue Cycle Process (To include Access, Insurance Verification, Record Coding Audits, Denials Management, Payer and Regulatory Appeals , and ... and Appeals . Serves as managing leader when reporting hospital denials, appeals , audit findings, and coding variations. Reports findings to appropriate… 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
- Centene Corporation (Jefferson City, MO)
- …a fresh perspective on workplace flexibility. **Position Purpose:** Responsible for leading clinical coding compliance nurses and non- clinical team members ... indicators + Identifies and implements best practices and operational efficiencies + Researches clinical and coding questions and issues + Triages and resolves… more
- Molina Healthcare (Layton, UT)
- …for a RN with experience with appeals , claims review, and medical coding . JOB DESCRIPTION Job SummaryProvides support for clinical member services review ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members… more
- Penn Medicine (Lancaster, PA)
- …Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn ... system. + Acts as a contact person for all non- clinical patient questions and concerns. + Reports pipeline status...a timely manner. + Works closely with Bariatric coordinator ( nurse ) to ensure special testing or clearances are obtained,… more