Pennsylvania Licensed Clinical Appeals Reviewer
VirtualVocationsFort Worth, Texas, United Statesjob_description.job_card.variable_hours_ago
serp_jobs.job_preview.job_type
- serp_jobs.job_card.full_time
job_description.job_card.job_description
A company is looking for a Clinical Appeals Reviewer.
Key Responsibilities
Process appeals while ensuring compliance with regulatory milestones
Review medical records for documentation and billing code compliance
Engage with appellants, providers, and members to gather necessary information for case determination
Required Qualifications, Training, and Education
Bachelor's degree (BSN) required
3 or more years of experience in a related clinical setting
Current and unrestricted Registered Nurse (RN) licensure
Working knowledge of InterQual criteria preferred
Proficiency in utilizing Electronic Medical Records (EMRs) and MS Office
serp_jobs.job_alerts.create_a_job
Clinical Reviewer • Fort Worth, Texas, United States
Job_description.internal_linking.related_jobs A company is looking for a Claims Specialist (PAWP).Key Responsibilities Adjust claims for assigned PAWP programs Build and maintain relationships with internal and external customers Investiga...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for an ABA Intake & Authorizations Admin Assistant - Spanish Speaking.Key Responsibilities Facilitate the client onboarding process and ensure accurate documentation and comm...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day A company is looking for a Health Claims Examiner I.Key Responsibilities Review medical documents to ensure completeness and validity for claim adjudication Determine covered services and calcul...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours A company is looking for a Remote Legal Administrative Assistant.Key Responsibilities Providing administrative support to the firm Assisting in handling communications with clients and co-counse...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day A company is looking for a Senior Claims Examiner I.Key Responsibilities Investigates and evaluates insurance claims through contact with involved parties Negotiates claims effectively to achiev...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for a Regulatory Counsel to join their legal team remotely.Key Responsibilities Research, interpret, and summarize state-specific regulations related to litigation support D...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for an Eligibility Specialist to manage and maintain accurate eligibility and enrollment records for health and welfare benefit plans.
Key Responsibilities : Process eligibilit...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for a Litigation Coordinator.Key Responsibilities Review and investigate cases to determine if litigation is viable for clients Maintain and develop client and attorney rela...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day A company is looking for a Senior Workers Compensation Claims Adjuster.Key Responsibilities Execute decision-making to analyze and resolve claims while managing claims exposure Interact with var...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for a Senior Claims Examiner to adjudicate complex life insurance claims.Key Responsibilities Lead the adjudication of complex or contested life insurance claims Conduct tho...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours A company is looking for a Workers' Compensation Claims Adjuster to manage complex claims in various jurisdictions across the United States.
Key Responsibilities Adjudicate higher complexity worke...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours A company is looking for an Enrollment - Eligibility Representative.Key Responsibilities Research benefits, eligibility, and site of care for Medicare Part B members Communicate with doctor's of...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day A company is looking for a Senior Claims Examiner I responsible for examining, investigating, and settling insurance claims efficiently.
Key Responsibilities Investigate workers' compensation clai...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day A company is looking for a Clinical Appeals Reviewer.Key Responsibilities Process appeals while ensuring compliance with regulatory milestones Review medical records for documentation and billin...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours A company is looking for an Accreditation Specialist to lead quality improvement efforts and ensure NCQA Health Plan Accreditation.
Key Responsibilities : Develops and prepares documentation for NC...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for a Claims Examiner, Medical Only.Key Responsibilities Investigate workers' compensation claims for medical care without lost wages Approve medical treatments, schedule ap...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for a Workers Compensation Claims Examiner III (Temporary).Key Responsibilities Manage a caseload of 150 to 180 workers' compensation files, including complex claims Conduct...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for an Insurance Information Coordinator - Remote.Key Responsibilities Verify member benefits, claims, and appeal information with insurance companies Research claims and in...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for a Claims Analyst to join their team in a remote capacity.Key Responsibilities Provide exceptional resolution of claim files to ensure a best-in-class claims experience I...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours A company is looking for a Stop Loss Filing Coordinator to manage the end-to-end stop loss claims process.Key Responsibilities : Prepare and submit stop-loss claims and supporting documentation A...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
- serp_jobs.job_card.promoted
California Licensed Claims Specialist
VirtualVocationsGrand Prairie, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
ABA Intake Admin Assistant
VirtualVocationsIrving, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Health Claims Examiner
VirtualVocationsIrving, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Remote Legal Administrative Assistant
VirtualVocationsCarrollton, Texas, United Statesserp_jobs.filters.remote
serp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
New York Licensed Claims Examiner
VirtualVocationsArlington, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Regulatory Counsel
VirtualVocationsCarrollton, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Eligibility Specialist
VirtualVocationsCarrollton, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Litigation Coordinator
VirtualVocationsCarrollton, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Michigan Licensed Claims Adjuster
VirtualVocationsIrving, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Senior Claims Examiner
VirtualVocationsArlington, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Workers' Compensation Claims Adjuster (FL, RI, TX Licensed)
VirtualVocationsCarrollton, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Medicare Eligibility Representative
VirtualVocationsCarrollton, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Arizona Licensed Workers' Comp Adjuster
VirtualVocationsCarrollton, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Pennsylvania Licensed Clinical Appeals Reviewer
VirtualVocationsCarrollton, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Accreditation Specialist
VirtualVocationsCarrollton, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Workers' Compensation Claims Examiner
VirtualVocationsCarrollton, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
California Licensed Claims Examiner
VirtualVocationsGrand Prairie, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Insurance Information Coordinator
VirtualVocationsCarrollton, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Licensed Claims Analyst
VirtualVocationsGrand Prairie, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Stop Loss Claims Coordinator
VirtualVocationsIrving, Texas, United Statesserp_jobs.job_card.full_time