- Medical Mutual of Ohio (OH)
- …workplace and perform pre-employment substance abuse and nicotine testing._ **Title:** _Clinical Appeal & Claim Review Nurse II_ **Location:** _Ohio_ ... + Independently evaluates basic to complex medical claims and/or appeal cases and associated records by applying clinical , regulatory, and… more
- Molina Healthcare (Nampa, ID)
- …+ Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience ... + Performs clinical /medical reviews of retrospective medical claim reviews, medical claims and previously denied...reports quality of care issues. + Assists with Complex Claim review including DRG Validation, Itemized Bill… more
- CVS Health (Springfield, IL)
- …of the Medical Director include support of the appeal process, clinical claim review process, pre-certification, and predetermination of covered ... of Aetna clinical and coding policy and experience with appeals, claim review , reimbursement issues, and coding is preferable, but a willingness to learn is… more
- St. Luke's University Health Network (Allentown, PA)
- …+ Resolve coding denials through claim correction or appeal . Claim corrections will be made after review of supporting documentation, CCI/LCD, carrier ... software tools and Insurance carrier medical and reimbursement policies during the claim review process. JOB DUTIES AND RESPONSIBILITIES: + Maintain current… more
- Centene Corporation (Atlanta, GA)
- …for experienced nurses with a strong background in **appeals, denials, utilization management, clinical review , and claims ** . **Preferred Requirements:** + ... + Background in utilization management and claims review If you're detail-oriented, comfortable making clinical ...reviewing applicable criteria, and analyzing the basis for the appeal + Ensures timely review , processing, and… more
- Baptist Memorial (Memphis, TN)
- …performing activities related to denied claims such as obtaining authorizations, claims review , patient billing, appeal writing, auditing, and/or denial ... appeal , collaborate with coding/billing for formulation of appeal with corrected claims and denial resolution...Physician Advisor communication may be necessary to provide further clinical review from the physician perspective as… more
- Baptist Memorial (Memphis, TN)
- …performing activities related to denied claims such as obtaining authorizations, claims review , patient billing, appeal writing, auditing, and/or denial ... appeal , collaborate with coding/billing for formulation of appeal with corrected claims and denial resolution...Physician Advisor communication may be necessary to provide further clinical review from the physician perspective as… more
- Beth Israel Lahey Health (Plymouth, MA)
- …contract changes as they pertain to level of care determination and the appeal /denial process. + Oversees utilization review workflow processes to ensure timely ... for identified deficiencies. + Facilitates peer-to-peer communication in support of submitted claims . + Participates on the Utilization Review Committee +… more
- R1 RCM (Chicago, IL)
- …what you will experience working as a Clinical Coding Appeals Nurse:** + Review and interpret medical records to appeal denied and underpaid claims . ... Clinical Coding Appeals Nurse** , you will help review and interpret medical records to draft appeals of...medical records to draft appeals of denied and underpaid claims . Every day you will review medical… more
- Molina Healthcare (Tacoma, WA)
- …of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and...specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long… more