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St. Luke's University Health Network
Overview
The RN Clinical Review Appeals Specialist conducts retrospective reviews of patient medical records and claims data to ensure accurate coding and DRG assignment. They develop appeal arguments and facilitate communication with various stakeholders to resolve documentation and coding issues.
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Compensation
Salary not listed
Posted
7 days ago
Mercy Cedar Rapids
The Clinical Documentation Specialist reviews medical records to ensure accurate reflection of patient conditions and services provided. They collaborate with physicians and the coding team to resolve documentation issues and manage denials related to medical necessity.
8 days ago
Aspirion
This entry-level role involves handling all administrative responsibilities, including processing incoming mail and retrieving documents while maintaining a HIPAA-compliant workspace. Key duties include documenting mail, accessing and securely uploading medical records, and ensuring documentation accuracy for timely account processing.
$18 / HOUR
14 days ago
Baptist Health
The Denials Management Specialist is responsible for validating dispute reasons, escalating payment variance trends, and generating appeals for denied or underpaid claims. This role involves resolving complex accounts through research of payer regulations and billing rules.
24 days ago
Sturdy Memorial Hospital
The RN Case Manager is responsible for assessing, coordinating, and facilitating patient progression through the continuum of care efficiently and cost-effectively by collaborating with the patient, family, physicians, and the interdisciplinary team. This involves early assessment of pre-admission needs, post-discharge requirements, resource review, and timely communication with all relevant stakeholders.
$43 - $67 / HOUR
28 days ago
The RN ED Case Manager assesses, coordinates, and facilitates patient progression through the continuum of care efficiently by assessing pre-admission needs and post-discharge requirements through timely communication with the healthcare team and patient/family. Responsibilities include using the ED tracking system to identify admissions, screening patients for payer source and level of care, and consulting with providers to determine appropriate status like observation versus inpatient.
$70,329 - $108,646 / YEAR
Catholic Health
Provide clerical and administrative support to the Care Management and Denials Management departments. Facilitate patient transitions to next levels of care by coordinating transportation, supplies, and necessary paperwork.
1 month ago
This role is responsible for providing clerical support to the Care Management and Denials Management Departments, assisting staff like Care Managers and Social Workers in facilitating patient transitions to the next level of care. Duties include managing incoming calls, assisting with concrete transition planning such as ordering supplies and transportation, and assembling paperwork for expedited appeals.
2 months ago
FULGENT THERAPEUTICS LLC
The Genetic Counselor Assistant will support licensed genetic counselors within the Benefits Investigation division by assisting in the review of patient cases and handling administrative tasks necessary for insurance coverage of NGS testing. This includes coordinating with clinicians and partners to obtain required information for prior authorization and coverage decisions.
Sentara Health
The Physician Advisor conducts timely and compliant medical necessity reviews and manages denials, including facilitating peer-to-peer discussions and writing appeal letters to support the centralized Utilization Review process for hospital facilities. This role also involves direct communication and education with attending physicians regarding status changes, regulatory requirements, and documentation integrity to support medical necessity.
The primary function is to provide clerical and operational support for the Physician Utilization Management Program, which involves administrative assistance to the Medical Director and Physician Advisors. Key duties include gathering medical records data for appeals, organizing data for submission, tracking outcomes of various coordination efforts, and maintaining program statistics and scorecards.
3 months ago
OakBend Medical Center
The Appeals Specialist will manage third party payer appeals and develop relationships to effectively appeal claims. They will also lead the denials management process and recommend improvements to reduce denials.
4 months ago
