- 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
- 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
- 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
- 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
- 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
- HonorHealth (AZ)
- …urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization, ... Learn more at HonorHealth.com. Responsibilities Job Summary Performs post payment clinical auditing in defense of hospital charges. This position audits patient… 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
- 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
- St. Luke's University Health Network (Allentown, PA)
- …appeal process. Assists billing staff regarding outpatient denials for experimental, coding or other issues that may require record review. Provides billing ... and commercial insurance rejections, denials for possible experimental services and coding issues, providing supplemental information to resolve claim. + Identifies… more
- UNC Health Care (Goldsboro, NC)
- … denials for validity and probability to overturn, proactively gathers required clinical documentation and formulates appropriate appeals . Coordinates the denial ... Advisors and subject matter experts for all audit and appeals work activities. Assists with documentation review to support...nursing licensure. Experience * Minimum 7-10 years of applied clinical experience as a Registered Nurse required.… more
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