- R1 RCM (Chicago, IL)
- …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you ... this remote production-drive position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical… 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% ... communicated payer decisions in a timely manner + Review clinical denials and initiate appeals process +...initiatives + Assess the quality of charge capture and coding as they relate to clinical denials;… more
- CVS Health (Hartford, CT)
- …zone of residence. **Position Summary** Responsible for the review and resolution of clinical appeals . Reviews documentation and interprets data obtained from ... support as required. This position may support UM, MPO, Coding , or Behavioral Health appeals . **Required Qualifications**...RN licensure in state of residence * 3+ years clinical experience **Preferred Qualifications** Appeals Experience *… more
- CDPHP (Albany, NY)
- …share these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and ... Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations… more
- St. Mary's Healthcare (Amsterdam, NY)
- …based on experience and other factors permitted by law. Responsibilities: * Uses clinical and coding knowledge to ensure accurate and compliant charge items ... and audit requests and coordinates attempts to overturn denials by drafting appeals , negotiating with payers, or following up with payer utilization review… more
- Carle (Urbana, IL)
- …resource in outpatient clinical documentation review to establish and manage clinical and prior authorization denial appeals for the Carle enterprise. ... Represents Carle in clinical meetings and writing appeals on outpatient accounts where medical necessity, level of care or prior authorization is questioned.… more
- ProMedica Health System (Toledo, OH)
- …services with payers & assist with appeal process when needed. Provides clinical review and document submission of pre-certification requests for oncology treatments ... duties listed below are essential unless noted otherwise* 1. Performs clinical review and document submission to obtain pre-certification/authorization requests for… more
- Trinity Health (Darby, PA)
- …time **Shift:** Day Shift **Description:** Trinity Health Mid-Atlantic is looking for Clinical Pre-Service Nurse Coordinator to join our Pre-Service team! ... be on location at 41 University Drive Newtown, PA 18940. **Summary:** The Clinical Pre-Service Nurse Coordinator is directly responsible for reviewing pre/post… more
- The Cigna Group (Bloomfield, CT)
- **Major Job Responsibilities** + Responsible for leveraging clinical and/or coding experience and perform facility and provider medical record reviews in support ... disputes (ie Claims XTEN, Prepay Vendors, etc.). + Utilize clinical data and/or coding guidelines, medical information,...2 or more years. + Experience with Medicare Advantage clinical reviews for claims, disputes or appeals .… more
- Molina Healthcare (Bowling Green, KY)
- …resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical ... Medical Surgical, or Pediatrics. Advanced Practice Nursing. Billing and coding experience. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Certified Clinical … more