- St. Luke's University Health Network (Allentown, PA)
- …ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- Evolent (Harrisburg, PA)
- …Stay for the culture. **What You'll Be Doing:** Job Description The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part ... of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of...work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators… more
- St. Luke's University Health Network (Allentown, PA)
- …near vision, visual monotony. EDUCATION: Graduate of an accredited professional nursing program. Registered nurse with current license to practice in the state ... experimental, coding or other issues that may require record review . Provides billing with information needed to obtain payment...and impact on revenue and trending. + Coordinates RAC appeals for complex case reviews for medical … more
- Healthfirst (PA)
- …productivity and quality for each Specialist against expectations + Prepare cases for Medical Director Review ensuring that all pertinent information (ie case ... + Bachelors degree + Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization… more
- Highmark Health (Monroeville, PA)
- …also building relationships across the organization in a community setting. **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care ... and outcomes. Interviews and collects patient specified data and chart review related to readmission. + Knowledgeable of and complies with accreditation… more
- Centene Corporation (Harrisburg, PA)
- …organization preferred LPN - Licensed Practical Nurse - State Licensure required or RN - Registered Nurse - State Licensure and/or Compact State ... claim reviews to ensure compliance with coding guidelines through a comprehensive review and analysis of claims, medical records, claims history, state… more
- Prime Therapeutics (Harrisburg, PA)
- …Patient Programs. **Education & Experience** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings and consults with...for work visa or residency sponsorship. **Additional Qualifications** + Registered Nurse ( RN ). + 5… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …as necessary collaboration/supervision agreements with Advance Practice Professionals (Certified Registered Nurse Practitioners or Physician Assistants) and ... Chief Medical Officer to include providing necessary research or review ; + Participating in the established on-call rotation including weekdays, weekends, nights… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …as necessary collaboration/supervision agreements with Advance Practice Professionals (Certified Registered Nurse Practitioners or Physician Assistants) and ... & Chief Medical Officer to include providing necessary research or review ; b. Participating in the established on call rotation including weekdays, weekends,… more