- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …is eligible for the eWorker persona.The TeamAs an integral part of the Clinical Appeals team, the Appeals Nurse Reviewer will serve as a liaison and ... healthcare? Bring your true colors to blue. The RoleThe Appeals Nurse Reviewer is responsible for reviewing...Payment Policy teams. Key Responsibilities: + Review provider claim appeals utilizing sound clinical judgement, medical policy,… more
- Molina Healthcare (Tampa, FL)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...more of the following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- …a Bachelors of Science in Nursing program required. + Minimum of 3 years of clinical experience as a Certified Professional Coder required. + Three to five years ... + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and...supporting documentation, as well as facilitates the completion of appeals in a timely manner. + Prepares trend and… more
- Molina Healthcare (Columbus, GA)
- …Billing and coding experience. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Certified Clinical Coder , Certified Medical Audit Specialists, Certified Case ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical … more
- Sharecare (Montgomery, AL)
- …available 3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and ... enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical,… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …manage people + This role reports to this job: MANAGER, PAYMENT INTEGRITY, CLINICAL + Necessary Contacts: In order to effectively fulfill this position the incumbent ... new applications is necessary. **Licenses and Certifications** + Nursing\RN - Registered Nurse - State Licensure And/Or Compact State Licensure Licensed RN in… more