healthcare services, continuity or care, and access to care clinical review determinations. The Utilization Management Nurse... authorization requests for medical necessity, coding accuracy and medical policy compliance. Clinical judgment and detailed...
analytics, AI, intelligent automation, and workflow orchestration. As our Clinical Coding Appeals Nurse, you will help review.... Here’s what you will experience working as a Clinical Coding Appeals Nurse: Review and interpret medical records to appeal denied and underpaid...
Experience in clinical documentation improvement, medical coding or medical documentation investigation preferred Professional... that have a strong clinical utilization management background. Medicare experience is a plus. Founded in 1934, Medical Mutual is the oldest...
and fair reviews of member and provider appeals. The nurse, utilizing standardized criteria, protocols, and guidelines... and provide coverage for the Appeals & Grievances in Clinical Claims Review. You’ll enjoy the flexibility to work remotely...
initial assessment review of appeals, medical records, and CMS/State Policies to determine if care/services provided meets... Clinical nursing judgment assessment and critical thinking skills, guided by regulatory policy, to make decision...
Clinical Appeals and CDI Specialist Full time & Part time/Remote $32 - $45 per hour Coding AID, a division... The Clinical Appeals and CDI Specialist uses clinical/nursing knowledge and understanding of national coding guidelines...
in our mission Reviews provider appeals and redeterminations using approved clinical and coding guidelines and documents appeal... as defined by the Nurse Licensure Compact (NLC), required Certified Professional Coder (CPC), Certified Coding Specialist (CCS...
in our mission Reviews provider appeals and redeterminations using approved clinical and coding guidelines and documents appeal... as defined by the Nurse Licensure Compact (NLC), required Certified Professional Coder (CPC), Certified Coding Specialist (CCS...
of clinical documentation and medical coding, and a working knowledge of patient financial billing regulations/requirements... secures authorization for the patient’s clinical services through timely collaboration and communication with payers...
, to patients throughout the region. Position Overview: Manages and reviews clinical denial appeals to payers. Coordinates... appeals for clinical denials to managed care/insurance companies and governmental agencies. Writes clinical appeals and audits...
General Summary of Position Responsible for coordinating and monitoring the denial management and appeals process.... Combines clinical, business and regulatory knowledge and skill to reduce significant financial risk and exposure caused...
will be considered if the applicant has extensive utilization, coding and compliance audit experience. Preferred: Registered Nurse (RN... License or other Clinical Licensure in State of Tennessee The Nurse Licensure Compact will not change how to obtain or renew...
and coding content that will drive decision-making and documentation for the Clinical Services, Quality and Appeals teams... for the development and performance of our clinical and coding products including Itemized Bill Review, DRG Validation...
and coding content that will drive decision-making and documentation for the Clinical Services, Quality and Appeals teams... for the development and performance of our clinical and coding products including Itemized Bill Review, DRG Validation...
information about this position. Support the authorization department through utilization of clinical knowledge with associated... treatments. Provides analysis of medical records to determine medical necessity in the clinical record and provides feedback...
information about this position. Support the authorization department through utilization of clinical knowledge with associated... treatments. Provides analysis of medical records to determine medical necessity in the clinical record and provides feedback...
management relative to one or more of the following categories: utilization management, coding, claims review, clinical appeals... and claims? If you answered yes, then this might be the job for you because AllMed is growing and we are adding a Clinical...
, as required. Assesses provider coding for accuracy and confirms charges are accurate based on clinical documentation. Outpatient...: Coding Certification Required - CPC or CCS certification Valid Registered Nurse License required Valid Motor Vehicle...
in the Clinical & Coding Advisory Team (CCAT) is a rare opportunity to work directly within Optum Payer Operations... appeals, development of clinical resources, and operations improvements. You’ll enjoy the flexibility to work remotely...
is a Registered Professional Nurse and expert Clinical Documentation Specialist, responsible for leading clinical documentation..., but are not limited to, Managers of Clinical Documentation, Director of Clinical Documentation, System Clinical Coding Leaders, Business...