- 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 (Salt Lake City, UT)
- …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
- Molina Healthcare (Austin, TX)
- …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
- St. Luke's University Health Network (Allentown, PA)
- …and/or formal meetings with auditor or payor representatives in defense of coding appeals , as needed. + Maintain necessary audit/appeal activity documents ... patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient...and CDMP Managers for education of the medical staff, clinical documentation professionals and the coding professionals… 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
- Elevance Health (Wallingford, CT)
- **Registered Nurse - Diagnosis Related Group Coding Auditor Principal - Carelon Payment Integrity** **Location:** Alternate locations may be considered. This ... appeals may only be reviewed by other DRG Coding Audit Principals (or Executives). **How you will make...medical audit activities. + Draws on extremely advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge… 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
- US Tech Solutions (Columbia, SC)
- …and appeals . Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. ... internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines. Responds… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …Medicaid Services (CMS) and other sources. + Liaise with Utilization Management and Clinical Appeals Departments to regularly review data from same specialty and ... (Required) + Registered Nurse , Physician's Assistant, or Nurse Practitioner with five (5) years' clinical ...of the following: pre-service review, post services review, and/or clinical appeals . (Required) + Superior clinical… 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 ... appeals specialists to meticulously investigate denied claims, prepare comprehensive appeals , and collaborate with clinical staff to ensure successful… more