- Centene Corporation (Columbus, OH)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by… more
- Molina Healthcare (Columbus, OH)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for ... verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired… more
- Molina Healthcare (Columbus, OH)
- …(Team will work on set schedule) Looking for a RN with experience with appeals , claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support ... for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical … more
- Cardinal Health (Columbus, OH)
- …+ Take any action necessary for any denials received by the payor to inform the clinician of changes that may need to happen to not delay patient care. + Complete ... any pre-service appeals to obtain paying approval based on medical necessity....Communicate effectively with all Revenue Cycle Management staff and clinical staff to ensure appropriate treatment can be provided,… more