- R1 RCM (Boise, ID)
- …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
- Trinity Health (Farmington Hills, MI)
- …**Description:** **POSITION PURPOSE** Work Remote Position (Pay Range: $39.8218-$59.7327) Applies clinical and comprehensive payer and appeals knowledge in ... review and resolution of claim escalations. Responsible for leveraging clinical and broad payer and appeals knowledge,...in the most timely manner possible: + Supports Supervisor Clinical Payment Resolution or Manager Clinical / Coding… more
- Trinity Health (Farmington Hills, MI)
- …and determining root causes of clinical denials. Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, ... best practices. The position will report directly to the Supervisor Clinical / Coding Payment Resolution. **ESSENTIAL FUNCTIONS** Knows, understands,… more
- CVS Health (Hartford, CT)
- …position are Monday-Friday 8a-5p in time zone of residence. Position Summary The Appeals Nurse Consultant position is responsible for processing the medical ... independently as well as in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates 7 days per week, 365… more
- CVS Health (Hartford, CT)
- …residence with occasional rotational weekend and holiday coverage. Position Summary The Appeals Nurse Consultant position is responsible for processing the ... in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates...licensure in state of residence + 3+ years of clinical experience Preferred Qualifications + Coding experience… more
- Universal Health Services (Richmond, VA)
- …https://uhs.com/ The Atlantic Region CBO is seeking a dynamic and talented Clinical Documentation Improvement (CDI) Nurse . The Clinical Documentation ... in this position + At least 5 years of clinical experience in an acute care setting + CCDS...criteria + Working knowledge of Medicare reimbursement system and coding structures preferred + Assertive personality traits to facilitate… more
- Rush Copley Medical Center (Aurora, IL)
- …The Appeals Specialist RN reviews inpatient hospital denials, clinical validation requests, and upheld denials after physician-to-physician (P2P) discussions ... then conducts appeals , as appropriate. Monitors and tracks denial outcomes with...insurance companies and revenue cycle leadership to prevent future clinical denials by communicating denial root causes and help… more
- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview The Clinical Coding and Audit Specialist monitors, responds and performs the clinical coding and audit ... position will also support detailed level reporting and analytics, clinical appeals , root cause analysis, and address...a current license/registration by state of hire as a nurse + Successfully completed HCS-D coding certification,… more
- Virtua Health (Marlton, NJ)
- …Coding Audit Response: Conducts Trains new coders to utilize the medical record, clinical , coding and abstracting systems, in conjunction with UHDDS and other ... over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques… more
- Actalent (Sacramento, CA)
- … and Grievances Manager. + In this role, you will perform accurate and timely clinical review of Member-initiated appeals . + The RNs perform first level appeal ... candidate will review both inpatient and outpatient Medicare member appeals for benefits, medical necessity, coding accuracy...compliance. + In this role, you will also perform clinical oversight of all Medi-Cal grievances. + In this… more
- Martin's Point Health Care (Portland, ME)
- …services requiring clinical review prior to payment. The Utilization Review Nurse will use appropriate governmental policies as well as specified clinical ... , and other compliance, or reimbursement related issues. Responsible for leveraging clinical and/or coding experience to perform facility and provider medical… more
- Universal Health Services (Richmond, VA)
- …with the Appeals Manager to coordinate the operational activities of the nurse auditor's workflow in the Appeals department. Key Responsibilities include: + ... Atlantic Region CBO is seeking a dynamic and talented Nurse Auditor Team Lead. The Nurse Auditor...account based on the medical record. + Identify all coding , clinical and charging documentation issues and… more
- Baystate Health (Greenfield, MA)
- …Outlook, CIS, SMS, MIDAS+ and Oracle information systems to retrieve and document clinical information accurately to track appeals cases and billing complaints. ... Medical Center** is looking for a **Per Diem** **Registered Nurse (RN), Case Manager** to join our Hospital Case...Association BLS CPR + Minimum 3 years acute care clinical nursing experience + Case Management experience **LOCATION** :… more
- Wesley Enhanced Living (Philadelphia, PA)
- …as a Best Workplace in our industry! Hiring Immediately! The Registered Nurse Assessment Coordinator (RNAC) provides for the initial assessment and periodic ... implement and update resident Plan of Care. The Registered Nurse Assessment Coordinator (RNAC) would: + Ensure accuracy of...accuracy of all sections of Multiple Data Set (MDS) coding to maximize company reimbursement consistent with the levels… more
- Centers Plan for Healthy Living (Brooklyn, NY)
- …+ Strong communication skills. + Building relationships + Working knowledge of clinical documentation requirements & Medicare Risk Adjustment coding Preferred: ... Nurse Practitioner - ISNP (Full-Time) Brooklyn, NY, USA...Reviews and manages pharmacotherapy of each member, collaborating with clinical pharmacist and physicians when necessary. + Prescribe appropriate… more
- Sharp HealthCare (San Diego, CA)
- …Day **FTE** 1 **Shift Start Time** **Shift End Time** California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians; Other ... care. **Required Qualifications** + Other : Graduate of an accredited Licensed Vocational Nurse (LVN) program + 3 Years experience in the acute patient care and/or… more
- Sharp HealthCare (San Diego, CA)
- …Day **FTE** 0 **Shift Start Time** **Shift End Time** California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians; Other ... care. **Required Qualifications** + Other : Graduate of an accredited Licensed Vocational Nurse (LVN) program. + California Licensed Vocational Nurse (LVN) - CA… more
- Virtua Health (Berlin, NJ)
- …billing process.* Maintains open communication with management regarding billing and coding issues including documentation, denials/ appeals , etc.* Follows up on ... over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques… more
- UNC Health Care (Chapel Hill, NC)
- …the unique communities we serve. RN Utilization Manager position specifically for a Utilization Manager/ Clinical Appeals Nurse . This person is based at the ... Hedrick building and is 100% on-site. This individual combines clinical , business, and regulatory knowledge to reduce significant financial risk caused by concurrent… more
- Trinity Health (Livonia, MI)
- …and refers findings for appropriate follow-up. 15. Reviews IP denials with the appeals nurse to determine appropriate status and reimbursement from payer. Appeal ... data gathering for identified projects, internal audits, retrospective reviews, statistics, coding , billing or verification issues. The UR Coordinator I will be… more