- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals . The Appeals Nurse ... and independent determination of the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets data obtained from clinical records… more
- St. Luke's University Health Network (Allentown, PA)
- …a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... formal meetings with auditor or payor representatives in defense of coding appeals , as needed. + Maintain necessary audit/appeal activity documents including Excel… more
- Highmark Health (Harrisburg, PA)
- …State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) Preferred + Bachelor's Degree in Nursing + 1 year ... + 1 year with continuous documentation improvement + CPR certification + Appeals Experience + Knowledge of CMS regulations and/or third party payer requirements… more
- Select Medical (Harrisburg, PA)
- …+ Obtaining insurance approvals and authorizations, as well as facilitating appeals for patients + Demonstrates positive referrer satisfaction and account retention. ... state licensure or eligibility for state licensure as a Registered Nurse , Physical Therapist, Occupational Therapist, or Speech Language Pathologist required.… more
- CVS Health (Harrisburg, PA)
- …accordance with contract. + Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) ... incoming correspondence and internal referrals. + Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs… more
- Sharecare (Harrisburg, PA)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- AmeriHealth Caritas (Philadelphia, PA)
- …Modification and LTSS UM Department, including authorization and approval of services, appeals and the coordination of benefits for all LTSS Participants. + Assists ... based on staffing levels, staff experience, and number/request types of authorizations/ appeals received. + Provides coaching and counseling to improve productivity… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …collaboration/supervision agreements with Advance Practice Professionals (Certified Registered Nurse Practitioners or Physician Assistants) and provide ongoing ... including but not limited to development of standards, insurance company appeals and teleconferences and provision of prior authorization information; +… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …collaboration/supervision agreements with Advance Practice Professionals (Certified Registered Nurse Practitioners or Physician Assistants) and provide ongoing ... including but not limited to development of standards, insurance company appeals and teleconferences and provision of prior authorization information; e.… more