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Rn Clinical Denials Management Specialist Remote Jobs

Insurance Denials Specialist Jobs
By Artius Solutions At United States
If candidate does not have EPIC experience, state what electronic medical record system they are using for working current denials.
Reviews all patient complaints and works to ensure a positive customer service experience by fully answering patient queries
Reviews denial reasons, validates accurate coding, and initiates appeals process for claims to ensure prompt and accurate payment.
Works to understand denial reason using provided information from payer
Collaborates with coding team, as needed, to ensure understanding of initial code selection and if updates are required
Researches payer-specific coverage policies to determine if an appeal is warranted
Rn Denials Specialist Jobs
By Ensemble Health Partners At , Remote
Case Management or Utilization Review experiences strongly preferred
Knowledge of patient insurance process and requirements preferred
2+ years of experience in an acute care hospital direct patient care setting required
Identifying the root cause for clinical claim denial
Reviewing medical records against nationally recognized clinical criteria guidelines (Interqual, MCG, NCD/LCD,DCA, etc.)
Using clinical decision making to determine the appropriate actions needed to recover or defend revenue
Clinical Quality Rn - Remote
By Optum At Minnetonka, MN, United States
Identify members requiring additional follow-up (e.g., referral to Case Management)
Demonstrate knowledge of Medicare and Medicaid benefit products including applicable state regulations
Assesses and interprets customer needs and requirements
Acts as a resource for others with less experience
Maintain HIPAA requirements for sharing minimum necessary information
Demonstrate knowledge of healthcare insurance industry products (e.g., HMO, PPO, ASO)
Clinical Program Coordinator Rn: Case Management (Remote)
By Providence Health Plan At , Beaverton, 97005, Or
Experience working with physicians in collaboration and management of patient care
Care coordination services include: disease management programs, including educating, motivating and empowering members to manage their disease
Current nursing experience in on of or a combination of the following areas: cardiology, endocrinology, pediatrics, obstetrics, oncology, respiratory, health education
Providence is calling a Clinical Program Coordinator RN: Case Management who will:
Provide care coordination, case management & care management services to Providence Health Plans(PHP) members.
5 years clinical nursing experience
Rn Clinical Manager - Ambulatory Care Management, Hybrid-Remote
By UCLA Health At , Los Angeles, 90095, Ca $92,800 - $183,600 a year

Description In this role, you will be responsible for providing leadership and management of clinical triage, complex case management, care planning, and development of post-acute strategies that ...

Specialist - Clinical Contracts - Scientific Alliance Management (Remote)
By Novo Nordisk At , Plainsboro, 08536, Nj $105 - $128 a day
Experience with Medidata Grant Manager Planning or another Clinical budget, FMV or benchmarking systems a plus
A minimum of 2 years of progressively relevant experience required; experience in clinical trial budget and contract negotiations is a plus
Results-driven team player, with excellent communication, organization, and interpersonal skills
Must be able to use time effectively; sets priorities in order to manage multiple projects with time sensitive deadlines
0-10% overnight travel required. The incumbent can work remotely from anywhere within the United States.
Negotiates budgets and contracts within Fair Market Value (FMV) and escalate issues for approval as required
Clinical Denials & Appeals Specialist (Registered Nurse) Remote
By Northwell Health At , Melville, 11747, Ny $78,000 - $130,000 a year

Remote Work Schedule: Sun-Thurs/8:30AM - 4:30PM

Clinical Program Coordinator Rn: Case Management (Remote)
By Providence Health Plan At , , Or
Experience working with physicians in collaboration and management of patient care
Care coordination services include: disease management programs, including educating, motivating and empowering members to manage their disease
Current nursing experience in on of or a combination of the following areas: cardiology, endocrinology, pediatrics, obstetrics, oncology, respiratory, health education
Providence is calling a Clinical Program Coordinator RN: Case Management who will:
Provide care coordination, case management & care management services to Providence Health Plans(PHP) members.
5 years clinical nursing experience
Rn Clinical Denials Management Specialist Remote
By AdventHealth Corporate At , Altamonte Springs, Fl
Experience in denial management, utilization review, case management, clinical documentation improvement, revenue integrity, or related field
Certification in Case Management (ACMA/CCM)
Bachelor’s degree in field such as nursing, management, business
Provide reports, education, and training on identified clinical denial trends and recommended remediation as required or requested by supervisors.
Minimum of three (3) years’ experience as Registered Nurse (RN) in an acute clinical setting
All the benefits and perks you need for you and your family: