- BJC HealthCare (St. Louis, MO)
- …work experience) **Additional Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist with infusion appeals ... government and commercial plans. This individual will be handling clinical denials and sending them to a nurse...clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be… more
- University of Washington (Seattle, WA)
- …**UW Medicine's Patient Financial Services Department** has an outstanding opportunity for a ** Clinical Appeals and Disputes Nurse .** **WORK SCHEDULE** + ... 100% FTE + 100% Remote + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ensures that payers are prepared to reimburse the UW Medicine… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- Molina Healthcare (Kearney, NE)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals ... Office suite/applicable software program(s) proficiency. **Preferred Qualifications** * Certified Clinical Coder (CCC), Certified Medical Audit Specialist … more
- Nuvance Health (Danbury, CT)
- *Description* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within the first 12-24 hours ... in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- McLaren Health Care (Mount Pleasant, 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
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- Omaha Children's Hospital (Omaha, NE)
- …and obtains appropriate physician documentation while patients are in-house for clinical conditions and procedures to support the appropriate severity of illness, ... and complexity of care of the patient. Exhibits sufficient knowledge of clinical documentation requirements. APR-DRG assignment and clinical conditions and… more
- Houston Methodist (Sugar Land, TX)
- …management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of care for ... and billing processes, managed care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of CPT and ICD… more
- CaroMont Health (Gastonia, NC)
- …for promoting and monitoring safe, high-quality, cost-effective healthcare with the best clinical outcomes possible. Provide physician and nurse education to ... and reporting. Perform data collection and analysis, trend identification for assigned clinical outcomes, and present this data at the appropriate meetings as… more
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