Remote DRG Nurse Appeals Specialist
$90k - $99kGainwell Technologies LLC
Florida, NY
- Remote job
Gainwell Technologies LLC is seeking a DRG Nurse Reviewer Appeals and Hearings to coordinate and perform appeal-related duties, including analyzing and responding to appeals, participating in hearings, and maintaining current clinical knowledge. The role requires an active RN license, relevant coding certifications, and strong communication skills. The position offers a salary range of $90,000.00 - $99,000.00 per year, with additional flexible benefits including a 401(k) match and health coverage. This is a remote role with up to 25% travel expected. #J-18808-Ljbffr Gainwell Technologies LLC
Vacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the Remote DRG Nurse Appeals Specialist in Florida, NY vacancy
$90k - $99k
A leading healthcare solutions provider seeks a DRG Nurse Reviewer Appeals and Hearings to coordinate appeal duties and engage in hearings, both... ...must have an active RN license and coding certification. This remote role offers flexibility and opportunities for career...Remote workFlexible hoursGainwell Technologies
Florida, NY2 days ago$90k - $99k
DRG Nurse Reviewer Appeals and Hearings- Remote Date: Jan 9, 2026 Location: Any city, FL, US, 99999 Work Mode: Virtual (Exception only) It takes great... ...Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA...Remote jobFull timeWork from homeFlexible hours- Santa Barbara Cottage Hospital is seeking a Senior Nurse Reviewer responsible for coordinating and facilitating clinical charge audits... ...Registered Nurse with extensive clinical experience. The job is remote during Eastern Standard Business Hours and offers a competitive...Remote work
$80k - $90k
...The Medical Review Clinical Appeals Auditor (RN) is responsible... ...with CPT/HCPCs/ICD-9/ICD-10/MS-DRG coding may be necessary. Strong... ...to work independently in remote setting with minimum supervision... ...good standing and diversified nursing experience providing direct care...Remote workFor contractorsImmediate startWork from homeHome officeFlexible hoursShift workPerformant
United States2 days ago$85k - $90k
...plan with employer match, paid parental leave, and more. The Nurse Coder DRG Auditor’s primary responsibility is to review medical records... ...commercial payers, InterQual, MCG, and Trend Health Partners Provide appeal responses for claims of the above types utilizing industry...Remote workWork at officeTrend Health Partners
New York, NY5 days ago- ...Grievances And Appeals Nurse Pride Health is hiring a Grievances and Appeals Nurse for a well-known client! (Remote Contract) Schedule: 5x8s Day shift Contract: 6 months Pay... ...terminology, ICD, CPT, HCPCS, and DRG codes Pride-Health offers eligible...Remote workContract workWork experience placementLocal areaDay shift
Pride Global
United States13 days ago - ...profile team, the full-time Clinical Analyst Appeals will manage clinical appeals and audit... ...commercial and government services in a remote setting, ensuring compliance with federal... ...experience and familiarity with CPT/HCPCs/DRG coding Applicable clinical or...Remote workFull time
Virtual Vocations Inc
United States4 days ago - ...claims, ensuring accuracy for reimbursement. The ideal candidate will have a strong background in medical coding with a focus on MS-DRG, certifications like RHIA or CCS, and the ability to work independently. The position offers a competitive salary, a bonus incentive...Remote workWork from home
Humana
Carson City, NV4 days ago $67.32k - $133.71k
...& Qualifications Purpose: The Clinical Appeals Nurse completes research, basic analysis, and... ...looking for an experienced clinician to work remotely from within the greater Baltimore... ...obtaining clinical opinions from physician specialists, to determine if adverse decisions are...Remote workWork experience placementWork at officeImmediate startCareFirst BlueCross BlueShield
Baltimore, MD5 days ago$90k - $110k
...DRG Revenue Integrity Auditor Remote CareNational is looking for an experienced DRG Revenue Integrity Auditor ! Ideal candidates will have... ...party vendor as a DRG Auditor or Clinical Documentation Specialist (CDS). ~ Prior experience working as a CDI/Coding auditor...Remote workImmediate startWork from homeCareNational
Plano, TX2 days ago$70k - $80k
Diagnosis Related Group (DRG) Auditor III Join to apply for the... ...! This role offers a fully remote work experience with possible... ...including strong uphold rates for appeals. Stay ahead of industry... ...United States . Remote Coding Specialists, Outpatient Surgery and Observations...Remote workFull timeWork experience placementReliefWork from homeHome officeRelocation package$85k - $95k
...integrity solutions including DRG Validation, Cost Outlier and Readmission... .... We are seeking a registered nurse with experience in clinical... ...CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder... ...applications at the same time Remote Work Requirements High speed...Remote workFull timeMonday to FridaySanta Barbara Cottage Hospital
New York, NY5 days ago- Actalent is seeking a team of UM/Appeals LPNs for a fully remote role. The Appeals Clinical Reviewer evaluates member and provider appeals for medical necessity, authorization decisions, and claims outcomes, applying guidelines and Medicaid regulations to ensure fair and...Remote jobPermanent employmentContract workWork from home
- Alignment Healthcare USA, LLC is looking for a full-time California Licensed Clinical Appeals Nurse to work in a fully remote environment. In this role, you will review and process appeals for inpatient and outpatient services, collaborate with medical directors, and ensure...Remote jobFull time
$50k - $55k
...integrity solutions including DRG Validation, Cost Outlier and Readmission... .... Under the direction of the Appeals Department leaders, the... ...the department. The Appeals Specialist level II performs research, investigation... ...frequent interruptions Remote Work Requirements High...Remote workMed Review Inc
New York, NY2 days ago- CareFirst, Inc. is seeking a full-time Clinical Medical Review Nurse to work remotely. In this role, you will manage the review of professional and institutional claims and provider appeals to determine eligibility for benefits. You’ll analyze medical information to support...Remote jobFull time
$87.76k - $116.71k
...appropriateness of denial and feasibility of appeal. Consults with attending physician,... ...Professionals; AACN Acute/Critical Care Nursing (Adult, Pediatric & Neonatal); MCG; ABMCM... ...preferred. Familiar with CPT, ICD‑9 &-10 and DRG coding preferred. Strong ability to...Remote jobFor contractorsLocal area$113.77k - $215.57k
Registered Nurse - Diagnosis Related Group Coding Auditor... ...in a hybrid model (remote and office). The ideal... ...-expense spending. The DRG Coding Auditor Principal... ...that disputes or appeals may only be reviewed by... ...as a Certified Coding Specialist, CIC as a Certified Inpatient...Remote workDaily paidWork at officeLocal area1 day per week- Sagility is seeking an Appeals and Grievance Coordinator who will manage and resolve member and provider complaints while adhering to regulatory requirements. This role involves conducting investigations, documenting actions, and ensuring compliance. As a key contact for...Remote jobWork from home
- ...Pride Health is seeking a Grievances and Appeals Nurse for a remote contract position. This role is vital in investigating and resolving grievances and appeals efficiently for a well-known client. Responsibilities include acting as a subject matter expert, ensuring compliance...Remote workContract work
PRIDE Health
Phoenix, AZ3 days ago - UnitedHealthcare is seeking a Physician Assistant to join the Appeals & Grievances team. You will adjudicate appeals across multiple plans... ...and the appeals staff to support coverage decisions. This remote U.S. role requires NCCPA certification, a PA license, 5+ years...Remote jobMonday to Friday
- ...independent attorney with licensing in New England states to join their collaborative remote team. The role involves managing cases in various legal areas including Medicaid, administrative appeals, and civil litigation. Applicants should have at least 3 years of legal...Remote jobWork from home
- ...Group, is seeking a Physician Assistant/Associate to join the Appeals and Grievances team. Under supervision of a Medical Director, you... ..., and contribute to process improvements while working remotely across the U.S. Ideal candidates have an active PA license, NCCPA...Remote job
- UnitedHealthcare is seeking a Physician Assistant to join our Appeals and Grievances team. In collaboration with Medical Directors, you... ...and adjudicate appeals for multiple health plans, working remotely from anywhere in the U.S. You will participate in team meetings...Remote jobMonday to Friday
- UT Southwestern Medical Center is seeking a Technical Denials Management Specialist II to review, research, and resolve denials and appeals within the Revenue Cycle. The role emphasizes collaboration, accurate documentation, and adherence to payer policies while leveraging...Remote jobWork from homeFlexible hours
- Elevance Health is seeking a DRG Clinical Validation Lead to oversee pre‑certification, reviews, and inpatient coding quality. This role is remote with occasional required in‑person training sessions, offering flexibility while ensuring onboarding and skill development....Remote job
- ...retrospective, and concurrent review of appeals for denied prior... ...including diagnosis-related group (DRG) validation, itemized bill... ...• At least 2 years clinical nursing experience, including at... ...CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager...Remote workFull timeWork at office
- ...Clinical Appeals Nurse - Full Time Remote - Jefferson Health Reviews payor denials and audits for potential lost revenue. Writes comprehensive, factual arguments to present to third-party payers, medical review boards, or other responsible parties applying clinical...Remote jobFull time
- Maximus is seeking a Senior Appeals Administrator for their California Independent Medical Review team. This role is vital in ensuring timely resolutions for medical review cases while enhancing the appeals process. The ideal candidate will have an associate degree with...Remote jobWork from homeFlexible hours
- ...for best heart programs. The Clinical Nurse Specialis t will work alongside the... ...Eligible. Certified Clinical Nursing Specialist in Virginia All Direct Care RN's required... .... For positions that are available as remote work, Sentara Health employs associates...Remote workTemporary workShift work
Sentara Health
Norfolk, VA3 hours ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote DRG Nurse Appeals Specialist. Be the first to apply!
Related searches
- clinical nurse specialist Florida, NY
- quality assurance manager remote Florida, NY
- frontend internship remote Florida, NY
- remote broker Florida, NY
- excel remote Florida, NY
- marketing intern remote Florida, NY
- data entry specialist remote Florida, NY
- remote support engineer Florida, NY
- remote contract attorney Florida, NY
- clinical data manager remote Florida, NY