Licensed RN Clinical Appeals Reviewer
VirtualVocationsMoreno Valley, California, United Statesjob_description.job_card.1_day_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 • Moreno Valley, California, United States
Job_description.internal_linking.related_jobs
AmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis.
We value new ideas, creativity, and productivity.We like ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for a Clinical Documentation Specialist - Home and Community Based Services (HCBS) - FT Days.Key Responsibilities Communicate with healthcare team members to ensure comprehen...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours A company is looking for a Patient Connection Authorization Associate to manage pre-certifications and authorizations for outpatient services.
Key Responsibilities Secure pre-certifications and au...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours A company is looking for a Patient Connection Authorization Associate to manage pre-certifications and authorizations for outpatient services.
Key Responsibilities Secure pre-certifications and au...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 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_variable_days 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 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_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_1_day 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_1_day A company is looking for a Prior Authorization Specialist to manage the initiation and processing of prior authorization requests.
Key Responsibilities Initiate, process, and oversee clinical revi...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 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_1_day 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_days 
Day 08hrs (United States of America).At CHOC, we strive to be the leading destination of children's health by providing exceptional and innovative care.
We are responsible for the overall health of...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for a Utilization Review Nurse (PRN).Key Responsibilities Review and evaluate electronic medical records for emergency admissions to assess medical necessity Apply clinical ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours 
MC : Clinical Documentation Imp-.The Clinical Documentation Specialist is responsible for concurrent clinical documentation review with an emphasis on completeness and accuracy of provider documenta...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for a Medical Records Specialist.Key Responsibilities Coordinate and oversee the collection and administration of medical records from healthcare providers Create thorough c...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 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_1_day 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_variable_days A company is looking for a Clinical Content Editor - PGY-1 / Medical Students.Key Responsibilities Collaborate with a multidisciplinary team to create and curate content on emerging medical technol...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours A company is looking for a Patient Access Specialist, Part-time, Days (Remote - Must reside in IL, IN, IA, or WI).Key Responsibilities Provide exceptional customer service and maintain patient co...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
- serp_jobs.job_card.promoted
Prior Authorization Specialist
AmeriPharmaLaguna Hills, CA, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
South Dakota Licensed Clinical Documentation Specialist
VirtualVocationsOntario, California, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Patient Authorization Specialist
VirtualVocationsIrvine, California, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Patient Authorization Associate
VirtualVocationsRiverside, California, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Michigan Licensed Clinical Document Specialist
VirtualVocationsCorona, California, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
RN Clinical Appeals Reviewer
VirtualVocationsCorona, California, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Pennsylvania Licensed Clinical Appeals Reviewer
VirtualVocationsMoreno Valley, California, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Health Claims Examiner
VirtualVocationsCorona, California, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
South Carolina Licensed RN Reviewer
VirtualVocationsRiverside, California, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Prior Authorization Specialist
VirtualVocationsFontana, California, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Licensed Physician Reviewer
VirtualVocationsSan Bernardino, California, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Missouri Licensed Prior Authorization Rep
VirtualVocationsSan Bernardino, California, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Practice Referral Coordinator, SOCPA
ChocMission Viejo, CA, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
State Licensed Utilization Review Nurse
VirtualVocationsIrvine, California, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Clinical Documentation Spec
Loma Linda University HealthLoma Linda, CA, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Medical Records Specialist
VirtualVocationsOntario, California, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
California Licensed Review Nurse
VirtualVocationsMission Viejo, California, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Remote Medical Insurance Verifier
VirtualVocationsOntario, California, United Statesserp_jobs.filters.remote
serp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
State Licensed Clinical Content Reviewer
VirtualVocationsSan Bernardino, California, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Patient Access Specialist
VirtualVocationsFontana, California, United Statesserp_jobs.job_card.part_time