- Penn State Health (Hershey, PA)
- …that prohibit or outlaw discrimination._ **Union:** Non Bargained **Position** Clinical Appeals Nurse - Revenue Integrity Process **Location** US:PA: ... appropriate reimbursement for medically necessary services. This position requires strong clinical judgment, knowledge of payer guidelines, and the ability to craft… more
- Cognizant (Washington, DC)
- … cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical ...stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care sites ... need the following: Required Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive… 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 ... to assess adequacy of implemented action plans. 6. Logs, tracks, refers and closes appeals timely. 7. Participates in the revenue cycle process (Central Business… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and compliance functions necessary to effect accurate and complete ... supporting documentation, as well as facilitates the completion of appeals in a timely manner. + Prepares trend and...focus audits and reports findings. + Serves as a clinical resource for coding / denial management and customer… more
- Stanford Health Care (Palo Alto, CA)
- …the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials. This position requires ... regulations, payor policies, and industry best practices related to clinical appeals and denials management. Evaluate internal...Spec required within 180 Days + RN - Registered Nurse - State Licensure And/Or Compact State Licensure required… more
- Montrose Memorial Hospital (Montrose, CO)
- Montrose, CO, USA | Clinical Revenue Integrity | Hourly | 34.10-54.56 per hour 34.10 - 54.56 | Full Time | Medical, Dental, Vision, 401K with match, PTO About ... of healthcare. About the "Department" + Montrose Regional Health revenue integrity is the auditing and active monitoring to...billed to the patient. About The Career: + The Clinical Denial Analyst is a key contributor within the… more
- UCLA Health (Los Angeles, CA)
- Description The Utilization Review Nurse is part of the Utilization Management Department at the Resnick Neuropsychiatric Hospital, supporting inpatient, partial ... hospital, and intensive outpatient programs. Performs clinical reviews with third party payors in order to...party payors in order to obtain authorization, supporting the revenue cycle. Acts as a liaison between third party… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and ... + Root causes claim denials, reprocesses, and submits claim appeals . + Creates drug cost estimates for both on-label...plans that require prior authorization. + Serve as a clinical resource to the Revenue Integrity and… more
- Nuvance Health (Danbury, CT)
- …and operational oversight for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while partnering with local case ... to foster a culture of collaboration, patient-centered care, and revenue optimization. This leader empowers denials/ appeals specialists...nurse (RN) * Minimum of 5 years of clinical experience in an acute care setting * Minimum… more