Clinical Claims Integrity Nurse — Appeals & Denials
BBSS Beyond Blue
BBSS Beyond Blue in Kentucky seeks a Clinical Denials Appeals Specialist to ensure accurate reimbursement by resolving denied claims through effective appeals. You will review denials, collaborate with clinical and billing teams to gather documentation, and develop strategies to improve revenue and outcomes. Responsibilities include coordinating with providers, coding, billing, and payer representatives, and handling appeals within required deadlines while ensuring compliance with standards of #J-18808-Ljbffr BBSS Beyond Blue
- ...by resolving denied claims through effective appeals processes. Reviews and analyzes denials to identify root causes... .... Collaborates with clinical and billing teams to... ...Bachelor’s degree in nursing, healthcare administration... ...review, payer integrity, utilization management...ClaimsContract workPart timeReliefInternshipShift work
- ...Denials Coordinator Hospital Billing Patient... ...denied insurance claims to help the hospital... ...coordinating the appeals process, collaborating... ...coding, billing, clinical) to develop and... ...labs, a school of nursing, and a leading school... ...it. Through the integration of its hospitals,...ClaimsFull timeTraineeshipLocal areaShift work
- ...Under general supervision, the Clinic Billing and Follow‑up... ...fundamental understanding of insurance claim processing, knowledge of HCFA... ...explanation of benefits (EOBs), handle denials, and perform follow‑up with... ..., including charge import, appeals, diagnostics and procedural...ClaimsWork at office
$86.1k - $107.85k
...Senior Clinical Reimbursement Specialist Remote... ...: We show up with integrity, kindness, and... ...and post-service appeals, mentor junior team... ...utilization management and claims adjudication),... ...Lead analysis of denial patterns and... ...Bachelor's degree in nursing. 3–5 years of experience...ClaimsRemote workShift work$29.7 - $31.8 per hour
...Description The Acute Coding Appeals Specialist integrates medical coding principles... ...Diagnosis Related Group, (DRG) denials in order to support the... ...assigned DRG and to address the clinical documentation utilized in... ...spreadsheets, account, and claim examples of root cause...ClaimsTemporary workWork at officeLocal areaRemote work- WPS Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level Medicare redeterminations to determine medical necessity... ...role requires an RN license, ASN/BSN, and 1+ year clinical experience, with strong communication and attention...ClaimsRemote job
- Appalachian Regional Healthcare (ARH) seeks a Clinic Billing and Follow‑up Specialist to manage essential billing and insurance... ...functions. The role requires understanding of insurance claim processing, EOBs, denials, and follow‑up with insurers to resolve claims and...Claims
- ## Denials Management SpecialistApplylocations... ...comprehensive clinical and regulatory review... ...of the claim. The position partners... ..., Unified Program Integrity Contractor (UPIC),... ...contractors.* Supports appeal development by analyzing... ...)*** Registered Nurse or other...ClaimsFor contractorsLive outWork at officeRemote work
- ...centered services across clinic, home, and community settings... ...We value accountability, integrity, teamwork, and... ...process, ensuring accurate claim submission, payment posting, denial management, and compliance... ...Submit corrected claims and appeals as needed Follow up with...ClaimsHourly payRemote workFlexible hours
$100k - $140k
...centered around delivering clinically strong, ethically... ...compliance, and revenue integrity are critical. Our... ...complex and high-value OON claims. The right candidate... ...navigating insurance carriers, appeals, authorizations, and... ...trends in denials and proactively implement...ClaimsFull timeContract workWork at officeRemote work1 day per week$29 - $52 per hour
...Caring. Connecting. Growing together. The Clinical Claim Review RN will be responsible for... ...Where applicable, the Auditor will support appeal and fraud investigation activities. This... ...Diploma/GED OR equivalent work experience Nurse licensure (RN or LPN) with a current,...ClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaRemote workMonday to FridayShift work- ## Revenue Integrity Analyst Full Time DaysApplyremote type... ...timely translation of clinical services into revenue... ...administration, Finance, Business, Nursing, or related field, or... ...issues prior to claim submission when... ...underpayment management and denial prevention efforts through...ClaimsFull timeWork experience placement
- Optum Insight is recruiting for a Clinical Claim Review RN to perform compliance reviews of medical and administrative documentation in Massachusetts... .... Full-time hours are 40/week with potential overtime and training aligned to your schedule. #J-18808-Ljbffr Registered NurseClaimsRemote jobFull time
- ...Responsibilities Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate... ...research and responds to system inquiries and appeals. Conducts research of claims systems and...Claims
- UnitedHealth Group is seeking a Clinical Claim Review RN in Massachusetts for full-time remote work. The role involves performing compliance reviews of medical and administrative documentation to identify fraud, waste, or abuse, using claims data, audits, and investigations...ClaimsRemote jobFull timeLocal areaShift work
- Appalachian Regional Healthcare Inc. is seeking a Clinic Billing and Follow-Up Specialist to manage essential billing and insurance... ...-up functions in a healthcare setting. You will handle claim processing, denials, EOB interpretation, and correspond with third-party payers...Claims
$50k - $60k
...practice to support hospital denials management to deliver... ...including Billing and Claims Submission, A/R Follow... ...to develop denial appeal letters for denials... ...credentialing, denials, and/or clinical teams as needed.... ..., deploy, and operate integrated/verticalized sector...ClaimsFull timeRemote workVisa sponsorship- Optum Insight is seeking a Clinical Claim Review RN to perform compliance reviews of medical and administrative documentation to identify fraud or wasteful practices. The role involves site visits, desk audits, and collaboration with a team of auditors to document findings...ClaimsRemote jobFull timeLocal area
- The Revenue Integrity/Accounts Receivable Representative is responsible... ...discrepancies, reduce denials, and enhance overall revenue... ...charge capture errors prior to claim submission.* Manage AR aging... ...Collaborate with coding, billing, and clinical teams to prevent recurring...ClaimsContract workWork experience placementCasual workLocal areaRemote work
- UF Health is seeking a denial management specialist to review denied claims, submit reconsiderations or appeals, and optimize enterprise revenue by reducing denials and improving reimbursements. This remote role requires residence in Florida or Georgia and entails collaboration...ClaimsRemote jobContract work
- Prime Therapeutics is hiring a Senior Clinical Pharmacy Technician for Medi-Cal Rx to work... ...authorization requests, eligibility, benefits and claims using established criteria and supports... ...and members on submission processes, appeals, and reimbursement guidelines across...ClaimsRemote job
- ...seeks a senior Patient Accounting Specialist to manage complex payer data, denials and appeals. You will process payments, audits, and communications with payers and providers, ensuring accurate claim submission and timely resolutions. The role requires 4+ years in...Claims
- UnitedHealth Group is seeking an Utilization Management & Clinical Validation RN to accurately review medical records and extract case details, crafting defensible appeal letters using evidence-based literature and coding knowledge. You will work from anywhere in the U...Remote jobFlexible hours
$2,316 per week
...Registered Nurse (RN) | Diabetes Location: Brooklyn, NY... ...companies. Lead the process to appeal denials of medications to ensure... ...continuous glucose monitors and integrate devices with mobile... ...information is available to the clinical team during in-person and virtual...Full timeContract workRemote workMonday to FridayShift workDay shiftAfternoon shift$20 - $25 per hour
...medicine combined with extensive clinical training. The practice is... ...accurately processing medical claims, managing insurance billing,... ...companies regarding claim status and appeals. Maintain accurate patient... ...and problem-solving abilities. Integrity Placement GroupClaimsHourly payPrivate practiceWork at officeMonday to Friday- ...also reflect our core values of integrity, excellence, and long-term service... ...the Billing Manager and broader clinic team to manage patient communications, claims submission, claims follow up, insurance... ...pending claims and assist with appeals on denied claims Monitor billing...ClaimsFull timeWork experience placementLocal areaRemote work
$85k - $95k
...accuracy, accountability, and clinical excellence to healthcare. As... ...leading authority in payment integrity solutions including DRG... ...We are seeking a registered nurse with experience in clinical validation... ...nurses with inpatient claims auditing experience or case management...ClaimsFull timeRemote workMonday to Friday$25 - $31 per hour
...lives. Ready to be the clinical judgment call that keeps... ...inpatient stay, every appeal that lands on your desk... ...substance abuse, skilled nursing, and rehab stays, for... ...reviews: Evaluate post-claim and post-service requests... ...the right cases: Route denial authorizations to the...ClaimsHourly payMonday to Friday$79.46k - $130.55k
Telephonic Nurse Case Manager II Sign on Bonus: $2000. Anticipated... ..., supports work-life integration, and ensures essential face-to... ...problem solving with providers, claims or service issues. Assists with... ...and minimum of 5 years of clinical experience; or any combination...ClaimsFull timeTemporary workWork at officeLocal areaRelocation packageMonday to FridayAfternoon shift1 day per week- ...direction and centralized leadership to the provider payment integrity and reimbursement policy functions inclusive of prepayment clinical and coding requirements and post payment recoupment, to promote accuracy in claims payment and correct coding to drive savings. Leads...Claims
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