Jobs
>
Chicago

    Clinical Appeals Nurse - Chicago, United States - R1 RCM

    R1 RCM
    R1 RCM Chicago, United States

    3 weeks ago

    Default job background
    Description

    R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry's most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.

    As our Clinical Appeals Nurse , you will help our hospital clients by serving as an expert on appeals and denials management where claims were denied by either governmental contractors or commercial payers. Every day you will thoroughly review patient clinical and hospital course documentation, as well as payer policy and denial information. Once reviewed, then you will prepare an appropriate written document and represent client hospitals during hearings if needed. To thrive in this role, you must have experience in a clinical inpatient environment working with a wide range of patient populations, and the ability to use sound judgment in reviewing clinical documentation supporting patient care as well as conceptual knowledge of the denials landscape. Proficiency in basic computer skills is essential for excelling in this remote, production-driven position.

    Here's what you will experience working as a Clinical Appeals Nurse:

    • Conduct a detailed review of patient medical records and payer denial information submitted by clients to assess the entire hospital stay and clinical course of the patient.
    • Identify risk factors, comorbidities, and adverse events to determine if payer denial was justified for that hospital stay or service using evidence-based guidelines.
    • Review governmental regulations, payer protocols, and/or medical policy to recommend appropriate actions.
    • Apply clinical judgment to support medical necessity appeals reviewing against appropriate coverage guidelines.
    • Leverage proficient writing skills to prepare written appeals.Represent clients at telephonic hearings if needed.

    Required Skills:

    • Active Registered Nurse license

    For this US-based position, the base pay range is $45, $87,948.00 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

    The healthcare system is always evolving — and it's up to us to use our shared expertise to find new solutions that can keep up. On our growing team you'll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

    Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package. )

    R1 RCM Inc. ("the Company") is dedicated to the fundamentals of equal employment opportunity. The Company's employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person's age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.

    If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at for assistance.

    CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent )

    To learn more, visit:

    Visit us on Facebook )

    #LI-AC01 #TJ2023

    R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry's most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation and workflow orchestration.

    Headquartered near Salt Lake City, Utah, R1 employs over 29,000 people globally and is traded on the Nasdaq stock exchange under the symbol "RCM."

  • Northwestern Medicine

    Rev Audit Contract Appeals Rn

    3 weeks ago

    Northwestern Medicine Chicago, United States

    **Remote work from Illinois, Wisconsin, Indiana, Missouri, Iowa, or Ohio** · **Description** · The **Rev Audit Contract Appeals RN** reflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with al ...

  • Sinai Chicago

    Utilization Management Analyst

    3 weeks ago

    Sinai Chicago Chicago, United States

    GENERAL SUMMARY/BASIC PURPOSE OF JOB: · This position provides monitoring of inpatient and outpatient accounts to ensure accuracy of submissions and proper authorizations are obtained in order to secure reimbursement. The success is measured by the ability to reduce bill holds. T ...

  • Northwestern Medicine

    External Transfer Coordinator

    2 weeks ago

    Northwestern Medicine Chicago, United States

    The **External Transfer Coordinator** reflects the mission, vision, and values of Northwestern Memorial, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and acc ...

  • Northwestern Memorial Healthcare

    External Transfer Coordinator

    2 weeks ago

    Northwestern Memorial Healthcare Chicago, United States

    **Company Description** · At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportu ...

  • Meridian Illinois

    Long Term Care Coordinator I

    2 weeks ago

    Meridian Illinois Chicago, United States

    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. ...

  • Trilogy Behavioral Healthcare

    Residential Recovery Counselor

    1 week ago

    Trilogy Behavioral Healthcare Chicago, United States

    Overview: · **$22.83 /Hr.** · **Schedule: Monday - Friday; 8:00 am - 4:30 pm** · **(This position requires a vehicle)** · The Residential SOAR Specialist (RSS) will provide support services to clients residing at Ogden Park Apartments and other Trilogy clients. They will assess t ...

  • Lakeview Rehabilitation & Nursing Center

    Business Office Manager

    3 weeks ago

    Lakeview Rehabilitation & Nursing Center Chicago, United States

    **We are looking for a Business Office Manager (BOM) to join our Team**: · ***: · Under the direction of the Administrator, the Business Office Manager oversees all business functions and personnel including but not limited to accounts receivable, accounts payable, resident trust ...

  • Vanator

    Clinical Analyst Rn

    1 week ago

    Vanator Chicago, United States

    Job Description**Job Purpose**: This position is responsible for conducting data collection and abstraction of medical records for HEDIS and Quality projects including supplemental data collection. Responsible for interacting with various internal staff, internal departments, and ...

  • Vanator

    Clinical Quality Research Analyst

    2 weeks ago

    Vanator Chicago, United States

    **Job Purpose**: This position is responsible for conducting data collection and abstraction of medical records for HEDIS and Quality projects including supplemental data collection. Responsible for interacting with various internal staff, internal departments, and network provid ...

  • Gateway Foundation Inc

    Development/ Fundraising Associate

    2 weeks ago

    Gateway Foundation Inc Chicago, United States

    Are you looking to find personal and professional fulfillment, and align your career with your values? · At Gateway Foundation, our employees have an opportunity to make a difference every day by helping people with substance abuse issues gain control of their lives. · Gateway Fo ...

  • Mercy Circle

    Major Gifts Officer

    5 days ago

    Mercy Circle Chicago, United States

    Mercy Circle is a faith-based continuing care and retirement community sponsored by the Sisters of Mercy located on Chicago's south side. Mercy Circle provides retirement apartments, assisted living, memory care, and skilled nursing care to individuals 62 years of age or older. W ...

  • Local 4 SEIU Health & Welfare Fund

    Claims Supervisor

    4 days ago

    Local 4 SEIU Health & Welfare Fund Chicago, United States

    : · **JOB TITLE**:Claims Supervisor** · **REPORTS TO**:Medical Benefits & Claims Manager** · **DEPARTMENT**:Medical Claims** · **POSITION TYPE**:Salaried, Exempt** · **BARGAINING UNIT**:Non-Bargaining Unit** · - SEIU Healthcare IL Benefit Funds is a dynamic benefits administratio ...

  • University of Illinois

    Hb Global Transplant Manager

    3 days ago

    University of Illinois Chicago, United States

    **HB Global Transplant Manager** · **Hiring Department**: Patient Accounting · **Location**: Chicago, IL USA · **Requisition ID**: · **Posting Close Date**: 5/10/2024 · **Salary Range**:$85,000-95,000 Commensurate with experience · **About UI Health** · The University of Illinoi ...

  • CITY VIEW MULTI CARE CENTER

    Activity Aide

    1 week ago

    CITY VIEW MULTI CARE CENTER Cicero, United States

    To succeed as an activity's assistant, you should strive to stage entertaining, engaging activities that will appeal to the age and physical or emotional condition of the client. You should be observant, driven, creative, and caring. · **Activities Assistant Responsibilities**: · ...

  • City View Multi Care Center

    Activity Aide

    1 week ago

    City View Multi Care Center Cicero, United States

    We are looking for a positive, compassionate activities assistant to schedule and coordinate events. The activities assistant will create and handle the logistics for daily, weekly, and monthly events to engage clients, residents, or patients. They will speak to participants to g ...

  • Radiant Innovations

    Nurse for Dermatology

    3 weeks ago

    Radiant Innovations Midway City, United States

    Are you passionate about helping people in your nursing profession and value joy in your work? · ▸ If respectful interaction in the workplace is important to you · ▸ If you are looking for a strong team and a good working atmosphere · ▸ If appreciation and recognition motivate yo ...

  • NovaTech Solutions

    Deputy Head of Nursing Services

    3 weeks ago

    NovaTech Solutions Oak Park, United States

    Are you passionate about helping people in your nursing profession and value finding joy in your work? · ▸ If respectful interaction in the workplace is important to you · ▸ If you are looking for a strong team and a positive work environment · ▸ If appreciation and recognitio ...

  • Omnia Healthcare Group

    Billing Specialist I

    2 weeks ago

    Omnia Healthcare Group Lincolnwood, United States

    Omnia Healthcare is seeking an** **Insurance **Billing Specialist** to join our growing team. This individual works at the home office for a large group of skilled nursing facilities. · **Billing Specialist Job Responsibilities**: · - Verify payments and ensure accuracy and compl ...

  • Stellar Enterprises

    Nursing specialist as practical instructor

    3 weeks ago

    Stellar Enterprises Maywood Park, United States

    Are you passionate about helping people in your nursing profession and value joy in your work? · ▸ If respectful interaction in the workplace is important to you · ▸ If you are looking for a strong team and a good working atmosphere · ▸ If appreciation and recognition motivate ...

  • Nexus Solutions

    Living area management

    4 days ago

    Nexus Solutions Maywood, United States

    Are you passionate about helping people in your nursing profession and value joy in your work? · ▸ If respectful interaction in the workplace is important to you · ▸ If you are looking for a strong team and a good working atmosphere · ▸ If appreciation and recognition motivate ...