Clinical Appeals RN - Nashville

We are currently seeking an experienced RN with strong interpersonal skills to join our team. The chosen Clinical Appeals & Coding RN would be responsible for reviewing appeals and grievances to determine if the appropriate care was given. · ...

We are currently seeking an experienced RN with strong interpersonal skills to join our team. · The chosen Clinical Appeals & Coding RN would be responsible for reviewing appeals and grievances to determine if the appropriate care was given. · ...

The Clinical Appeals Nurse is responsible for handling appeals requiring clinical input or interpretation.,Responsibilities · ,Compose clinical appeal letters to send to payers for denial considerations utilizing documentation, contract language, or voice recordings as applicable ...

+The Clinical Appeals Specialist is a key clinical expert within the new Revenue Recovery Team at Amplify RCM. · +Perform comprehensive reviews of denied claims,focusing on clinical issues such as medical necessitylevel of care non-covered services,and authorization-related denia ...

The Supervisor, Clinical Appeals oversees the coordination of audit and medical necessity denial appeals for their assigned team.This role ensures timely and accurate appeal submissions, compliance with regulatory standards, and the achievement of service and production goals. · ...

The Supervisor Clinical Appeals oversees the coordination of audit and medical necessity denial appeals for their assigned team. · Supervises the team responsible for reviewing preparing and submitting medical necessity denial appeals in accordance with standardized processes and ...

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The Denials Management Specialist position at Houston Methodist leads in reviewing coordinating monitoring clinical denial management appeals process collaborating with Central Business Office management clinical partners to reduce financial risk exposure caused by denials. This ...

The Claims Appeals Specialist is responsible for reviewing and processing claims for pre services and post service grievances and appeals requests from customer types (i.e. member, provider, regulatory and third party) related to clinical and non-clinical services, · quality of s ...

· Hybrid schedule: Nashville TN · About Lucent Health  · Lucent Health combines top-tier claims management with a compassionate, human-focused, data-driven care management solution. This approach helps self-insured employers provide care management that enables health plan parti ...

BlueCross BlueShield of South Carolina is hiring an Appeals Analyst to research and analyze complex appeals and retrospective review requests.Research the substance of service appeals by both member and provider based on clinical documentation. · Perform thorough research of appe ...

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team.Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.Po ...

The Utilization Specialist proactively monitors utilization of services for patients to optimize reimbursement for the facility. · ...

+Job summary · The Collections Coordinator is responsible for performing all collections functions after claims have been submitted and processed. · +ResponsibilitiesExecutes targeted follow-up on outstanding accounts with Medicare, Medicaid, and commercial carriers based on AR a ...

+The Claims Appeals Specialist is responsible for reviewing, analyzing and processing claims for pre services and post service grievances and appeals requests from customer types (i.e. member, provider, regulatory and third party) and multiple products (i.e. HMO, POS, PPO, EPO, C ...

This role requires leading strategic engagement with payers and ensuring policy compliance across all payer types including Commercial Medicaid and Medicare. · The Director will manage responses to Special Investigation Unit SIU inquiries and refund requests ensuring timely and a ...

We are currently hiring for an Appeals Analyst to join BlueCross BlueShield of South Carolina. In this role as Appeals Analyst, you will research the substance of complex appeal or retrospective review requests including pre-pay and post-payment review appeal requests. · Addition ...

· The Director, Payer Policy Relations is responsible for leading strategic engagement with payers and ensuring policy compliance across all payer types, including Commercial, Medicaid, and Medicare. This role requires staying current with evolving payer policies and implementin ...

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. · ...

The Director Denials Management provides leadership for the audit, appeal and review process to preserve and recover revenue while maintaining the highest level of clinical and regulatory integrity and compliance. · Oversee the process for direction and support to clinical and op ...