Licensed RN Clinical Appeals Reviewer

VirtualVocationsSan Jose, California, United States

job_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 an IBR Clinical Appeals Reviewer who will analyze and respond to client and hospital claim review appeal inquiries.

Key Responsibilities :

Analyze scope and resolution of IBR Appeals and respond to various levels of appeals

Perform complex analyses, identify risk factors, and recommend appropriate actions based on regulations and medical policies

Collaborate with auditors and prepare written appeals while navigating web-based portals and online tools

Required Qualifications :

Undergraduate nursing degree

Unrestricted RN (registered nurse) license

2+ years of appeals experience (coding or auditing)

Experience with CPT-4 coding and advanced knowledge of ICD10 CM and ICD 10 PCS coding

Advanced experience with regulations, compliance, and composing professional appeal responses

serp_jobs.job_alerts.create_a_job

Clinical Reviewer Rn • San Jose, California, United States

Job_description.internal_linking.related_jobs

serp_jobs.job_card.promoted

Healthcare Transactions Associate Attorney - S.F.

Direct CounselSan Francisco, CA, US

serp_jobs.job_card.full_time

Job Description : Midlevel Healthcare Transactions Associate.Location : San Francisco, Washington, Chicago, Houston, San Diego, Dallas, Los Angeles, Menlo Park, New York, Costa Mesa, Del Mar.Direct C...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30

serp_jobs.job_card.promoted
serp_jobs.job_card.new

Licensed Physician Reviewer

VirtualVocationsOakland, California, United States

serp_jobs.job_card.full_time

A company is looking for a Physician Reviewer - Utilization Review.Key Responsibilities Conduct timely medical reviews to ensure compliance with quality parameters Make clinical determinations b...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours

serp_jobs.job_card.promoted

RN Clinical Appeals Reviewer

VirtualVocationsSanta Clara, California, United States

serp_jobs.job_card.full_time

A company is looking for an IBR Clinical Appeals Reviewer - Remote.Key Responsibilities Analyze and respond to IBR Appeals inquiries Perform medical record reviews and prepare written appeals C...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30

serp_jobs.job_card.promoted

Patient Screening Specialist

VirtualVocationsSan Francisco, California, United States

serp_jobs.job_card.full_time

A company is looking for a Patient Screening Specialist to efficiently screen, schedule, and guide patients through the clinical trial process. Key Responsibilities Conduct phone screenings to ass...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days

serp_jobs.job_card.promoted
serp_jobs.job_card.new

South Carolina Licensed RN Reviewer

VirtualVocationsSan Francisco, California, United States

serp_jobs.job_card.full_time

A company is looking for an RN Medical Reviewer II to perform medical reviews and support medical claims processing.Key Responsibilities Conduct medical claim reviews for complex services and det...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours

serp_jobs.job_card.promoted
serp_jobs.job_card.new

California Licensed Review Nurse

VirtualVocationsSan Francisco, California, United States

serp_jobs.job_card.full_time

A company is looking for a Pre-Service Review Nurse RN to work remotely in the Pacific or Mountain Time Zones.Key Responsibilities Conduct utilization management, including Prior Authorization Re...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours

serp_jobs.job_card.promoted

Remote Medical Insurance Verifier

VirtualVocationsSan Francisco, California, United States

serp_jobs.filters.remote

serp_jobs.job_card.full_time

A company is looking for a Remote Medical Insurance Verification Specialist.Key Responsibilities Assist patients with obtaining coverage for prescription medications Make inbound / outbound calls ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day

serp_jobs.job_card.promoted

Massachusetts Licensed Patient Engagement Specialist

VirtualVocationsSanta Clara, California, United States

serp_jobs.job_card.full_time

A company is looking for a Patient Engagement Specialist with a MA Pharmacy License.Key Responsibilities : Proactively coordinate medication refills and adjudicate pharmacy claims Make outbound p...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days

serp_jobs.job_card.promoted

Clinical Liaison

Lifepoint Health®Los Gatos, CA, US

serp_jobs.job_card.part_time

Facility Name : El Camino Health Los Gatos Hospital.At Lifepoint Rehabilitation, we are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others.He...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days

serp_jobs.job_card.promoted
serp_jobs.job_card.new

Health Claims Examiner

VirtualVocationsOakland, California, United States

serp_jobs.job_card.full_time

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_1_hour

serp_jobs.job_card.promoted

Senior Epic Patient Experience Analyst

TEKsystemsOakland, CA, United States

serp_jobs.job_card.full_time

Must travel onsite once a month •.Must have certifications in Welcome, MyChart, Hello World or Cheers •.Epic Patient Experience Analyst to lead and optimize our digital patient engagement and contact...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day

serp_jobs.job_card.promoted

Medicare Eligibility Representative

VirtualVocationsSan Francisco, California, United States

serp_jobs.job_card.full_time

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

serp_jobs.job_card.promoted
serp_jobs.job_card.new

Pennsylvania Licensed Clinical Appeals Reviewer

VirtualVocationsHayward, California, United States

serp_jobs.job_card.full_time

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

serp_jobs.job_card.promoted
serp_jobs.job_card.new

Missouri Licensed Prior Authorization Rep

VirtualVocationsHayward, California, United States

serp_jobs.job_card.full_time

A company is looking for a Prior Authorization Representative in Revenue Cycle Management.Key Responsibilities Validate patient information, scheduled tests / surgeries, and insurance details to en...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours

serp_jobs.job_card.promoted

Michigan Licensed Clinical Document Specialist

VirtualVocationsSan Francisco, California, United States

serp_jobs.job_card.full_time

A company is looking for a Clinical Document Specialist for a full-time remote position.Key Responsibilities Utilize clinical, coding, and Clinical Documentation Integrity (CDI) knowledge to enha...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day

serp_jobs.job_card.promoted

Healthcare Transactions Associate Attorney - Menlo Park

Direct CounselMenlo Park, CA, US

serp_jobs.job_card.full_time

serp_jobs.job_card.promoted

Healthcare Associate Attorney

Vivo HealthStaffSan Francisco, CA, US

serp_jobs.job_card.full_time +1

Vivo HealthStaff is recruiting for a Healthcare Associate Attorney for a nationally recognized law firm.This is a full-time permanent position with office locations in Los Angeles, Chicago, and St....serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30

serp_jobs.job_card.promoted
serp_jobs.job_card.new

Senior Epic Patient Experience Analyst

Softworld IncSan Francisco, CA, US

serp_jobs.job_card.full_time

Job Title : Senior Epic Patient Experience Analyst Job Location : San Francisco CA 95695 and / or Oakland, CA, San Francisco, CA, Sacramento, CA, Alpharetta, GA, Harrisburg, PA, Hybrid 1-2 days a week ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours

serp_jobs.job_card.promoted

Trauma Registrar

University of California - San Francisco Campus and HealthSan Francisco, CA, United States

serp_jobs.job_card.part_time

Involves data collection and reporting to patient care data registries, often national.Implements methods for collecting, analyzing, storing, retrieving and reporting patient medical information an...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days

serp_jobs.job_card.promoted

eBilling Coordinator

Liberty Personnel Services, Inc.San Francisco, CA, United States

serp_jobs.job_card.full_time

A nationally recognized law firm with 500+ attorneys providing comprehensive legal services to innovative companies from startups to global enterprises. The eBilling Coordinator plays a critical rol...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days