: Minimum Education A Bachelor's Degree in Nursing preferred; three (3) years of clinical care or nursing experience... CCM (certification in case management) is preferred. License Required Must be licensed as a Registered Nurse by the...
and compose a comprehensive rebuttal via the appeal process in a timely manner to the DRG denial claims for clinical and coding... denials that are received from the insurer/auditor. Successful appeals result in our upholding the clinical support and the...
and compose a comprehensive rebuttal via the appeal process in a timely manner to the DRG denial claims for clinical and coding... denials that are received from the insurer/auditor. Successful appeals result in our upholding the clinical support and the...
be an integral part of our vision to make healthcare better for everyone. At Optum, you’ll have the clinical resources, data...-to-day management of the clinical staff (QI Nurses) within the Grievance/ Peer Review Lane of the Optum CA Quality...
of Maryland to practice as a Registered Nurse. Possess sufficient previous experience in clinical health care including direct... appeals. Coordinate with healthcare team members to update care plans and track quality indicators as well as CMI. Create...
Practical Nurse preferred. Minimum of one (1) year of relevant work experience (i.e. hospital billing, coding or prior pre... based applications and/or internet resources; obtains clinical information from physician offices and/or Bryan system...
for understanding clinical documentation and how it relates to medical coding, coding guidelines and payer rules. Essential Duties... reported. Provides expertise to Accounts Receivable Staff in addressing appeals for denials due to potential coding errors...
and follow up, commercial and state Medicaid appeals, preparation for state Medicaid state fair hearings. Prepares refunds... and prepares commercial/Medicaid payer claim denial reconsiderations and or formal disputes as needed on non clinical denials based...
Coordinator is a finance-related position requiring clinical skills to coordinate the process of providing accurate and timely... and monitor compliance with 60% rule. Responsible for monitoring patient charts for correct coding and electronically transmitting...
, and appeals. (Required) 2 years Experience related to CPT and ICD coding assignment. (Required) Required Skills/Knowledge... to payor requirements, authorizations, appeals and patient navigation. Works as a Payor Clearance Specialists use quality...
peer reviewers Consults with a nurse reviewer, clinical peer reviewer or the Medical Director with questions Prepare case... transformation of the eyewear and eyecare industry. GENERAL FUNCTION The Sr. Specialist- Utilization is a nurse leader...
peer reviewers Consults with a nurse reviewer, clinical peer reviewer or the Medical Director with questions Prepare case... transformation of the eyewear and eyecare industry. GENERAL FUNCTION The Sr. Specialist– Utilization is a nurse leader...
efforts to optimize the Cancer Center Charge capture. Works with Director, Managers, Physicians and Nurse Practitioner in the..., clinical documentation of services performed and collection of patient co-payments and balances. Monitor performance...
Management Nurse is considered a clinical expert in Denial Management and Avoidance and ensures all denied claims are accurately... with Revenue Cycle, Physicians, Admissions, Coding, and Coordinated Care staff to answer clinical questions specific to denial...