- Penn State Health (Hershey, PA)
- …that prohibit or outlaw discrimination._ **Union:** Non Bargained **Position** Clinical Appeals Nurse - Revenue Integrity Process **Location** US:PA: ... appropriate reimbursement for medically necessary services. This position requires strong clinical judgment, knowledge of payer guidelines, and the ability to craft… more
- Cognizant (Harrisburg, PA)
- … cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical ...stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is… more
- St. Luke's University Health Network (Allentown, PA)
- …include volumes, number of appeals , case resolution, and impact on revenue and trending. + Facilitates retrospective clinical record reviews for ... regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data… more