• Clinical Coding Appeals

    R1 RCM (Boise, ID)
    …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you ... this remote production-drive position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical… more
    R1 RCM (08/13/25)
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  • Clinical Appeals Nurse RN

    HCA Healthcare (Nashville, TN)
    …**Introduction** Do you want to join an organization that invests in you as a Clinical Appeals Nurse RN? At Parallon, you come first. HCA Healthcare ... make a difference. We are looking for a dedicated Clinical Appeals Nurse RN like...root cause of each denial and apply company specific coding for trending and analysis. + Update the patient… more
    HCA Healthcare (08/16/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Omaha, NE)
    …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...pharmacy, etc.). + Experience demonstrating knowledge of ICD-9, CPT coding and HCPC. + Experience demonstrating knowledge of CMS… more
    Molina Healthcare (08/20/25)
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  • RN Clinical Review Appeals

    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
    St. Luke's University Health Network (07/08/25)
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  • Clinical Denial Appeals Specialist

    TEKsystems (Annapolis, MD)
    The Clinical Denials Appeals Specialist plays a critical role in identifying, mitigating, and preventing clinical denials. This is a Direct Placement ... clinical denials, determine appropriate next steps, and lead appeals efforts by analyzing medical necessity, addressing authorization issues, and resolving… more
    TEKsystems (08/09/25)
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  • Clinical Denials & Appeals

    Northwell Health (Melville, NY)
    …needed. Preferred Skills 3-5 years experience in Utilization Review, Case Management, and Clinical Appeals . 3-5 years of acute inpatient clinical experience. ... for the Health System. Reviews denial trends and identifies coding issues and knowledge gaps. Job Responsibility Serves as...with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to… more
    Northwell Health (08/20/25)
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  • RN Provider Appeals Coordinator (Hybrid)…

    Henry Ford Health System (Troy, MI)
    …GENERAL SUMMARY: Unit Description: Health Alliance Plan (HAP) is looking to grow our Medical Appeals Team with an experienced Registered Nurse ! We are a team of ... RN PROVIDER APPEALS COORDINATOR - MEDICAL APPEALS -...+ Minimum of two (2) years of experience in clinical management of patients in an inpatient or ambulatory… more
    Henry Ford Health System (08/20/25)
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  • Profee Clinical Data Quality Admin (CDQA)…

    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
    Virtua Health (07/28/25)
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  • Medical Coding Specialist

    US Tech Solutions (Columbia, SC)
    …regarding claim/encounter information to correct deficiencies. + 10% Provides coding guidance to clinical review staff. Develops necessary ... reference materials for review staff. + 5% Consults with appeals , provider outreach and education and other supported areas...year either ICD-9, DRG, APC, HIPPS, HCPCS, or RUG coding and validation; or 2 years: 1-year clinical more
    US Tech Solutions (08/20/25)
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  • Utilization Review Nurse

    US Tech Solutions (Columbia, SC)
    …+ NICE TO HAVE skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral Health or infusion therapy ... line of business. Previous Medicare experience and /or UR experience/Process Appeals requests/can have experience in either Utilization management or Appeals more
    US Tech Solutions (07/31/25)
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