- CVS Health (Columbus, OH)
- …The Appeals Nurse Consultant plays a key role in resolving clinical complaints and appeals by reviewing medical records and applying clinical ... We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Position Summary**...care. **Key Responsibilities** + Administers review and resolution of clinical complaints and appeals . + Interprets data… more
- CVS Health (Columbus, OH)
- …support cost-effective quality care for members. Administers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical ... regulatory and accreditation requirements for members and providers. Coordinates clinical resolutions with internal and external support areas. **Required… 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 Clemens, 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
- Virtua Health (Mount Laurel, NJ)
- …Coding Audit Response: Conducts Trains new coders to utilize the medical record, clinical , coding and abstracting systems, in conjunction with UHDDS and other ... over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques… more
- Fairview Health Services (St. Paul, MN)
- …Reviews and analyzes medical records and coding guidelines to formulate coding arguments for appeals and/or coding guidance for potential ... critical research and timely and accurate actions including preparing and submitting appropriate appeals or re-billing of claims to resolve coding denials to… 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
- 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
- Molina Healthcare (Warren, MI)
- …for a RN with experience with appeals , claims review, and medical coding . **Job Summary** Utilizing clinical knowledge and experience, responsible for review ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical … 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