what we do, as individuals and professionals, every day. Under the general direction of the Senior Manager, Clinical Revenue Management (CRM...), the Clinical Revenue Management Specialist (CRMS) performs a wide range of system wide clinical revenue management...
and payer issues. 9. Ensures inpatient clinical payor denials are reviewed for appeal potential. Files formal appeals with the... Manager, Clinical Revenue Management (CRM), the Clinical Revenue Management Specialist (CRMS) performs a wide range of system...
statements for inclusion in policy documents. Liaise with Clinical Appeals Department to regularly review data from same..., or Nurse Practitioner with five (5) years' clinical experience. (Required) Four (4) years of health plan experience...
within Promise Clinical Team. The Case Management Nurse, Senior will report to the CSP Manager. In this role you will be Perform... guidelines. Conducts clinical review of claims for medical necessity, coding accuracy, medical policy compliance and contract...
or reviewing appeals, post-service experience highly preferred. Background with billing and coding or claims review. Broad clinical... at the nurse level when possible and sending cases to a medical director as needed. Strong computing skills...
and coding content that will drive decision-making and documentation for the Clinical Services, Quality and Appeals teams... development and performance of our clinical and coding products including Itemized Bill Review, DRG Validation, Outpatient...
and coding content that will drive decision-making and documentation for the Clinical Services, Quality and Appeals teams... development and performance of our clinical and coding products including Itemized Bill Review, DRG Validation, Outpatient...
Nurse. 2. Three (3) years of clinical nursing experience. 3. Two (2) years of experience in medical coding... and enter ICD-10, CPT, and HCPCS codes based on clinical documentation and ensure accurate risk adjustment coding for chronic...
of professional, inpatient or outpatient, facility benefits or services, and appeals. Documents decisions using indicated protocol... sets or clinical guidelines. Provides support and review of medical claims and utilization practices. May provide...
coverage to federal employees, retirees, and their family. The FEP Utilization Management Nurse Consultant (Lead) will report..., policies and nationally recognized clinal criteria. Conduct clinical review of prior authorization, concurrent, and post...
but saving them. Together. Alignment Health is seeking a remote Utilization Management (UM) Nurse - Pre-service... (Must have North Carolina LVN / RN License) to join the UM team. As a UM Nurse, you will be responsible for reviewing requests for pre...
for reviewing, analyzing, and resolving denied medical claims related to clinical services. This position collaborates with clinical... staff, payers, and revenue cycle teams to ensure accurate documentation, proper coding, and appeal submission. The...
that physician documentation supports current clinical level of care. Communicating and collaborating with Intake Nurse/Care...Job Description: JOB PURPOSE & MISSION Responsible for utilization of clinical and financial resources by: ensuring...
authorization management of denials and submission of appeals. Provides training and mentoring to other employees within the..., and telephone skills required. Knowledge of medical terminology and CPT-4/ICD-9 coding preferred. Detail oriented, organized...
organization; based on review findings and previous history Consult with Nurse Reviewer and clarify as needed Contact provider... & SKILLS: Excellent written and verbal communication skills Medical terminology and coding knowledge Experience handling...
verification of coding, billing and supporting clinical documentation. Coordinate all activities associated with insurance carrier... range at the time of the offer. Responsibilities Coordinate payer denials and appeals, respond to insurance company requests...
audit results in a clear, concise, and effective manner using clinical guidelines and ICD 10 CM/PCS coding rules... clinical or coding validation audit experience. Prefer candidate with prior DRG retrospective overpayment identification...
Salary $38 - $53.30 / hourly Overview Are you a Registered Nurse (RN) with Medicare experience? Do you consider... Tuition Reimbursement Program for Clinical Tracks Shift Differentials Full Benefits Package 401k PLUS Employer Matching...
. is one of the nation's largest correctional health care providers. Over the past 30 years, our team of dedicated clinical...' best interests by helping to ensure appropriate care and maximizing clients' medical benefits; 2. Reviews clinical information...
the continuum of care. Required Qualifications Other : Graduate of an accredited Licensed Vocational Nurse (LVN...) program. California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians...