- LA Care Health Plan (Los Angeles, CA)
- …of Microsoft Office suite, including Word, Excel and PowerPoint. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Payment Integrity Nurse Coder RN III Job Category: Clinical Department: Claims...policies within the claim adjudication process through medical record review for Payment Integrity and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …with Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and...Mandates. + May be responsible for pricing, coding, researching claims to ensure accurate application of contract benefits and… more
- Nuvance Health (Danbury, CT)
- …percentage of charge reimbursement payers. * If concurrent inpatient case does not meet medical necessity review criteria during the first level review , ... Days, Evenings, Nights available* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within… more
- AdventHealth (Riverview, FL)
- …business or healthcare related field 3 years clinical experience in healthcare related field Registered Nurse ( RN ) This facility is an equal opportunity ... be caring for:** AdventHealth Riverview AdventHealth is expanding our medical expertise, innovation, and state-of-the-art technology to southern Hillsborough County… more
- Molina Healthcare (Salt Lake City, UT)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Carnival Cruise Line (Miami, FL)
- …health team to assess fitness for duty per International Maritime Health guidelines. + **Crew Medical Claims Management** + Review crew cases of high risk ... return-to-work planning in compliance with regulations and employment obligations. + Support disability claims and benefits review for crew unable to return to… more
- Adecco US, Inc. (Minneapolis, MN)
- …or local law; and Holiday pay upon meeting eligibility criteria. **IMPORTANT:** This ** Registered Nurse ** role is being recruited for by Adecco's Healthcare & ... Adecco Healthcare & Life Sciences is hiring remote RN Appeals Reviewers! This role is remote /...criteria, rendering approvals when appropriate. . You will summarize medical information for review by the … more
- Stanford Health Care (Palo Alto, CA)
- …180 Days or + CCDS - Cert Clinical Document Spec required within 180 Days + RN - Registered Nurse - State Licensure And/Or Compact State Licensure preferred ... while identifying instances of overpayments and underpayments. Proficiency in healthcare claims analysis, including the ability to review , interpret, and… more
- MD Anderson Cancer Center (Houston, TX)
- …reviews and audits of patient accounts to complete Defense Audits. *Ideal Candidate:* A * Registered Nurse ( RN )* with experience in *appeals* and * nurse ... insurance medical directors, case management, and utilization review to request reconsideration and/or appeal of claims...remote. Prefer Houston/local area. *LICENSES AND CERTIFICATIONS* * Required: RN - Registered Nurse -… more
- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will ... Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for...adjudication, clinical coding reviews for claims , settlement, claims auditing and/or utilization review required +… more