- R1 RCM (Chicago, IL)
- …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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …extensive clinical , regulatory, business, and coding knowledge. The Senior Clinical Appeals Nurse Reviewer Supervisor works closely with Clinical ... Bring your true colors to blue. The RoleThe Senior Clinical Appeals Nurse Reviewer Supervisor...provider and facility claims appeals and authorization appeals . + Use comprehensive knowledge of coding … more
- Fairview Health Services (St. Paul, MN)
- …hospital. 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
- Centene Corporation (Austin, TX)
- … coding / clinical decisions on first time claims, adjustments and appeals in accordance with correct coding guidelines and Centene payment policies. ... by performing medical claim reviews to ensure compliance with coding guidelines through a comprehensive review and analysis of...a managed care organization preferred LPN - Licensed Practical Nurse - State Licensure required or RN - Registered… more
- City and County of San Francisco (San Francisco, CA)
- … documentation reflects the appropriate level of service. + Utilizes both clinical and coding knowledge effectively. + Performs initial inpatient chart ... EXPERIENCE: At least one (1) year of experience working as a Registered Nurse SPECIALTY REQUIREMENTS: + Clinical Documentation Specialist (CCDS) certification +… more
- Molina Healthcare (WI)
- …supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous claims and appeals experience. The candidate must have ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical … more
- Henry Ford Health System (Troy, MI)
- …medical records to determine accuracy of billing through verification of coding , billing and supporting clinical documentation. Coordinates all activities ... GENERAL SUMMARY: Coordinates payer denials and appeals , responds to insurance company requests for medical...coding processes and terminology specific to audit processes, clinical procedures, disease states, and other topics as indicated.… 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
- US Tech Solutions (Columbia, SC)
- …and appeals . Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. ... as needed for meetings and training. + Typical day will be reviewing clinical for pre-certifications for durable medical equipment, home health care and elective… more
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