- 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)
- …worth of each individual is recognized. Submit your application for the opportunity below: Clinical Appeals Nurse RN Parallon **Benefits** Parallon offers a ... benefits may vary by location._** We are seeking a Clinical Appeals Nurse RN for...root cause of each denial and apply company specific coding for trending and analysis. + Update the patient… more
- Molina Healthcare (Green Bay, WI)
- …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
- 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
- Virtua Health (Mount Laurel, NJ)
- …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... between 7am- 7pm depending on meetings with clinicians. Summary: Responsible for coding quality and audits, education and training, etc. for ICD-10-CM, CPT and… 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
- 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
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a **Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale AFB, ... accordance with References (e) and (o). After following the directed methodology for appeals , the MTF will also adhere to its respective Service or joint commands'… 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 3-5 years of applied clinical experience as a Registered Nurse required.… more