- Molina Healthcare (Dallas, TX)
- …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
- Elevance Health (Chicago, IL)
- …set of clinical domains, including radiology, cardiology and oncology. The ** Appeals Nurse Reviewer I** is responsible for conducting preauthorization, out ... ** Appeals Nurse Reviewer I** **Location:** This...reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. **How you will make an… more
- McLaren Health Care (Mount Clemens, MI)
- …outcomes and fulfills the obligation and responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer ... + Certified Medical Coder, Certified in Healthcare Compliance, Certified Coding Specialist, or Certified Clinical Documentation Specialist certifications 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
- Fairview Health Services (St. Paul, MN)
- …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 (Harrisburg, PA)
- … 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
- Molina Healthcare (Warren, MI)
- …for a RN with experience with appeals , claims review, and medical coding . **Job Summary** Utilizing clinical knowledge and experience, responsible for review ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical … 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
- 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
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