- 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
- CVS Health (Hartford, CT)
- …of the Wheelchair DME consultant include support of the appeal process, clinical claim review process, pre-certification, and predetermination of covered ... Knowledge of Aetna clinical and coding policy and experience with appeals, claim review , reimbursement issues, and coding is preferable, but a willingness to… more
- Molina Healthcare (Warren, MI)
- …set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, ... + Performs clinical /medical reviews of retrospective medical claim reviews, medical claims and previously denied...clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review .… more
- Molina Healthcare (Rochester, NY)
- …Minimum three years clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review . **Required License, Certification, ... * Performs clinical /medical reviews of retrospective medical claim reviews, medical claims and previously denied...of proactive approaches to improve and standardize overall retrospective claims review . * Ensures core system is… more
- Veterans Affairs, Veterans Health Administration (Tampa, FL)
- … review , and dispositions PCAFC initial eligibility decisions; reassessments; and appeal decisions for clinical eligibly determinations. Ensure alignment of ... of meetings related to the CSP Program. Analyze data obtained in record review for use in determining clinical eligibility for PCAFC. Document information… more
- SSM Health (MO)
- …areas. The scope of responsibility is all post-billed denials (inclusive of clinical denials). Engages with key leadership including regional leaders to identify and ... correct root cause of denied claims through process improvements, set goals, measure process effectiveness...contributor to achieve goals. Lead projects to improve denial claim performance, compliance and efficiency within the denials process… 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
- Humana (Lansing, MI)
- …on claims denials, rejections or underpayments related to high rate of claim denials, common claims errors, and provider complaints. + Assist the Provider ... submission expectations including code edit tools and updates, remittance review , overpayment, appeal /dispute functionality, virtual credit card payment… more
- Humana (Springfield, IL)
- …carrying out Humana's proactive approach to minimize claims denials through claims education and training. The Claim Research and Resolution Professional ... on claims denials, rejections or underpayments related to high rate of claim denials, common claims errors, and provider complaints + Assist the Provider… more
- Humana (Lansing, MI)
- …on claims denials, rejections or underpayments related to high rate of claim denials, common claims errors, and provider complaints. + Assist the Provider ... submission expectations including code edit tools and updates, remittance review , overpayment, appeal /dispute functionality, virtual credit card payment… more
Recent Jobs
-
Senior Program Manager - Site Merchandising
- Chewy (Bellevue, WA)
-
Behavioral Health Medical Assistant
- Adelante (Mesa, AZ)
-
Lead Fire Sprinkler Technician
- Impact Fire (Southborough, MA)
-
RN Advanced Cardiopulmonary Care
- Corewell Health (Grand Rapids, MI)