to assist with appeal defense process. RAC/Payer Audit Nurse: Support denials and appeals within the Payer Audit department... Denial Management Nurse: Support the denial and appeal process within the Payer Denial Management department. Coordinate...
customer first. Works directly and courteously with patients by providing information and explanation of billed clinical... entry for payments for various physicians and nurse practitioner receipts 5) Responds to insurance correspondence...
, visit EXL USA Healthcare is looking for a CVA Nurse Auditor III - DRG Coding. This position is a full-time, work from home... referrals for DRG coding review. Responsibilities: Conduct MS-DRG and/or APR-DRG clinical reviews to verify the accuracy...
related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. Assess... rules and regulations. Requirements Licensure / Certification / Registration: Registered Nurse credentialed from the...
related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. Assess... rules and regulations. Requirements Licensure / Certification / Registration: Registered Nurse credentialed from the...
related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. Assess... rules and regulations. Requirements Licensure / Certification / Registration: Registered Nurse credentialed from the...
related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. Assess... rules and regulations. Requirements Licensure / Certification / Registration: Registered Nurse credentialed from the...
related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. Assess... rules and regulations. Requirements Licensure / Certification / Registration: Registered Nurse credentialed from the...
Why consider applying to Visiting Nurse & Health Services of CT? Here are a few reasons: - Small territories... coding and documentation initiatives, infection control program and records management. Quality Manager monitors all data...
related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. Assess... rules and regulations. Requirements Licensure / Certification / Registration: Registered Nurse credentialed from the...
and prepares commercial/Medicaid payer claim denial reconsiderations and or formal disputes as needed on non clinical denials based.... Maintains online payer resource reference library related to payer policies utilized for follow up and or appeals. Reviews...
. In this fully remote position as a Home Health Auditor you will apply your expert clinical knowledge in the auditing of Home Health... rationales. You will also apply your extensive clinical and industry knowledge to identify audit trends. Key Responsibilities...
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...
, 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...
Practical Nurse preferred. Minimum of one (1) year of relevant work experience (i.e. hospital billing, coding or prior pre..., physician offices, patients, and utilizing web based applications and/or internet resources; obtains clinical information...
and appeals to the appropriate person or team. The CMR will submit reviews in a timely manner for payers. Review, index... notification to the Utilization Review team for any denials. Sends clinical updates to insurance companies to obtain approval...
Preferred Qualification: Demonstrated knowledge of process flow of UM including, clinical appeals and guidance reviews... medical record for accuracy of the coding on the MMQ/MDS, to support accuracy and payment to the nursing facility Utilize...
with managed care and coding departments to maintain accuracy in clinical and billing information.... Communicates with supervisor or charge nurse, physicians, practice staff when there are issues with authorization. ONCOLOGY...
Utilization Review Nurse will also be responsible for issuing pre-authorization approvals/denials, notifying providers/enrollees.... Collects and/or documents all required enrollee clinical and co-morbidity information during the pre-authorization process...
Preferred Qualification: Demonstrated knowledge of process flow of UM including, clinical appeals and guidance reviews... medical record for accuracy of the coding on the MMQ/MDS, to support accuracy and payment to the nursing facility Utilize...