- R1 RCM (Detroit, MI)
- …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
- R1 RCM (Chicago, IL)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Supervisor** , you will ... guidelines. **Here's what you will experience working as a Clinical Coding Appeals Supervisor:** +...on a routine basis. **Required Skills:** + Active Registered Nurse license + Active AHIMA or AAPC Coding… more
- 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 ... Nurse Reviewer is responsible for reviewing provider claims appeals , validating coding and medical necessity of...This position requires strong clinical and medical coding skills to review provider claim appeals … 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...pharmacy, etc.). + Experience demonstrating knowledge of ICD-9, CPT coding and HCPC. + Experience demonstrating knowledge of CMS… more
- City and County of San Francisco (San Francisco, CA)
- … documentation reflects the appropriate level of service. + Utilizes both clinical and coding knowledge effectively. + Performs initial inpatient chart ... EXPERIENCE: At least one (1) year of experience working as a Registered Nurse SPECIALTY REQUIREMENTS: + Clinical Documentation Specialist (CCDS) certification +… more
- CaroMont Health (Gastonia, NC)
- …pre-existing criteria sets and/or clinical evidence from existing library of clinical coding references and/or regulatory arguments. Search for supporting ... and monitoring safe, high-quality, cost-effective healthcare with the best clinical outcomes possible. Provide physician and nurse ...role between CDS workflow and DRG Denial Management and Appeals based on departmental needs. The Clinical … more
- St. Luke's University Health Network (Allentown, PA)
- …appeal process. Assists billing staff regarding outpatient denials for experimental, coding or other issues that may require record review. Provides billing ... and commercial insurance rejections, denials for possible experimental services and coding issues, providing supplemental information to resolve claim. + Identifies… more
- UNC Health Care (Goldsboro, NC)
- …the Physician Advisors and subject matter experts for all audit and appeals work activities. Responsibilities: 1. Provides leadership, clinical expertise and ... denials for validity and probability to overturn, proactively gathers required clinical documentation and formulates appropriate appeals . Coordinates the denial… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- …defense, LifeNet and special focus audits and reports findings. + Serves as a clinical resource for coding / denial management and customer service issues. + ... + 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)
- …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