Remote DRG Nurse Reviewer & Appeals Specialist
$95k - $110kGainwell Technologies
- Remote job
Gainwell Technologies is seeking a DRG Nurse Reviewer Appeals and Hearings professional for remote work. You will coordinate and perform appeal duties, analyze documentation, prepare case files and participate in hearings, both virtual and on-site as needed. Required are an active US RN license, CPC/CCS/CPMA certification, and 5+ years of clinical or coding experience. Expect remote work with up to 25% travel for onsite hearings and a salary range of $95,000-$110,000. #J-18808-Ljbffr Gainwell Technologies
$95k - $110k
...DRG Nurse Reviewer Appeals and Hearings- Remote It takes great medical minds to create powerful solutions that solve some of healthcare's most complex... ...Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA...Remote workFull timeWork from homeRelocation packageFlexible hours$95k - $110k
Gainwell Technologies is seeking a DRG Nurse Reviewer Appeals and Hearings professional for remote work. You will coordinate and perform appeal duties, analyze documentation, prepare case files and participate in hearings, both virtual and on-site as needed. Required are...Remote job$50k
...authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. The Appeals Specialist I is responsible for performing triage,... ...atmosphere of frequent interruptions Remote Work Requirements ~ High speed internet (10...Remote workContract workWork experience placement- ...Medica is seeking an Appeals and Grievance Specialist to manage member complaints, grievances, and regulatory inquiries, ensuring timely, accurate... ...Operations, Health Services, Legal, and Markets. This is a remote position with a competitive total rewards package. #J-1...Remote work
$65k - $116.75k
...RCM Inc. is seeking a Clinical Coding Appeals Nurse to review medical records, draft appeals of denied... ...claims, and ensure accurate coding of DRG revisions using ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidance. This is a remote, independent, production-driven role requiring...Remote job- ...To support a growing remote team, the full-time Appeals and Grievance Specialist will manage and resolve complaints, grievances, and appeals from members and providers while ensuring compliance with applicable requirements. Key responsibilities Manage and resolve complaints...Remote workFull time
$21.16 - $38.37 per hour
A healthcare provider is seeking a Medicare Appeals & Grievances Specialist to handle member appeals and grievances. This remote position requires strong experience in managed care, particularly with Medicare regulations. Ideal candidates will have excellent attention...Remote workHourly payWork at office- ...Managing complex payer deferrals, denials, and appeals, the full-time remote Appeals Resolution Specialist will support timely resolution and successful authorization... ...appeal submissions. Key responsibilities Review and manage assigned deferrals, denials, and appeals...Remote workFull timeWork at office
$56.27k - $69.9k
...Appeals or Grievances Specialist II Working Title: Appeals Specialist II FLSA Status: Exempt Posting... ...6,270 - $69,898 Office Location: Remote within North Carolina. Make an... ...submission, your resume will be reviewed to ensure it meets the essential criteria...Remote workWork at officeLocal areaImmediate startWork from homeFlexible hours- A leading healthcare consulting firm is seeking a Grievance & Appeals Coordinator I for a contract role. Responsibilities include managing member appeals, ensuring compliance with CMS guidelines, and maintaining a high productivity benchmark. Candidates need a high school...Remote workContract work
- UT Southwestern Medical Center is seeking a Technical Denials Management Specialist II in the Revenue Cycle Department to review, research, and resolve claim denials and appeals for various insurers, while identifying payment trends to maximize collections. This WFH role...Remote jobWork at officeWork from home
- ...assigned levels of denials by submitting appeal letters and required documentation to insurance... ...filing time limits. Submit external review requests and required documentation to... ...patient to get the denial overturned. Remote: Although this position is listed as remote...Remote work
- ...TEKsystems is seeking a Denials Specialist for a fully remote 3-month contract supporting a healthcare organization's Revenue Cycle team. Focus is... ...resolving commercial payer claim denials, AR follow-up, and appeals within Epic. Start date 9/21, pay $26 per hour. Must...Remote workHourly payContract work
- ...Member Appeals Specialist Primary responsibilities would include triaging incoming appeals/grievances... ...necessary for the case at hand Reviewing the appeal request to determine if... ...workflow (Specialists, Supervisor, Quality Nurses, Medical Directors, Pharmacy Team)...Remote workTraineeship
- ...Insurance Appeals Specialist Medical Data Systems Inc. is seeking a detail-oriented and motivated Insurance Appeals Specialist to join our insurance support and billing team. The ideal candidate will demonstrate professionalism, independence, and a strong understanding...Remote workFull timeWork at office
- ...Denials Specialist Insight Global is seeking a fully remote Denials Specialist to support a Healthcare AI client. This... ...will leverage their denials and appeals expertise to evaluate and improve... ...potential to extend) Responsibilities: Review denied claims and evaluate AI-...Remote workContract workPart timeMonday to FridayFlexible hoursShift workWeekend work
$20.08 - $30.06 per hour
CERIS is hiring an Appeals Representative in Fort Worth, Texas. The role involves reviewing and addressing provider inquiries and appeals while ensuring compliance with relevant regulations. The successful candidate will have strong attention to detail, excellent communication...Remote jobHourly pay$21.16 - $38.37 per hour
...Join to apply for the Medicare Appeals & Grievances Specialist (PST Hours) role at Molina Healthcare . This position is remote and will be working Pacific Standard hours.... ...and grievance outcomes. Requests and reviews medical records, notes, and/or detailed...Remote workHourly payFull timeContract workWork experience placementWork at office- ...ensuring adherence to official coding guidelines and client guidelines. This role supports DRG outcomes with CC/MCC consideration and requires abstracting data elements during chart reviews. The position offers telecommuting within the United States, a competitive benefits...Remote job
- UT Southwestern Medical Center in Dallas, TX, seeks a Technical Denials Management Specialist II to review, research, and resolve claim denials and appeals for various insurers, maximizing collections. The role emphasizes follow-up and resolution of denied claims with...Remote job
$60.78k
...purpose. Job Summary The Appeals and Grievances (A&G) Specialist II will receive, investigate and... ...requirements. This position reviews pre-service authorizations, concurrent... ...hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in...Remote workLocal areaShift workWeekend work- ...healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and... ...case resolutions. This is a 100% remote role requiring an RN, LPN, or... ...practice and knowledge of Utilization Review Guidelines. The position offers a competitive...Remote work
- Sacbar is seeking an experienced Inpatient Hospital Coder - Denial Appeals Specialist in Towson, MD to review and write compelling appeals for DRG-related denials. The role requires strong inpatient coding knowledge, MS-DRG assignment, clinical documentation, payer policies...
- CorVel Corporation, via its CERIS division, is seeking an Appeals Representative to review and address provider inquiries and appeals by email, fax, telephone, or written correspondence in accordance with regulatory guidelines, client policy and instructions, and industry...Remote job
- UnitedHealth Group is seeking a professional Medical Coder with inpatient and DRG expertise for hospital-based coding. You will assign ICD-10-CM/PCS codes, review charts, and ensure compliance with coding guidelines. The role emphasizes accuracy, productivity, and ongoing...Remote job
- ...maintain coding accuracy, and support coding quality initiatives across the team. Requires AHIMA/AAPC credentials, 3+ years inpatient DRG coding, and strong Excel/EMR skills. Telecommuting from anywhere in the U.S. is available, with occasional overtime as needed. #J-18...Remote job
- ...Remote Medicaid Case Manager We are seeking a detail-oriented and highly adaptable professional to join our fully remote team, focusing on managing cases across multiple Medicaid health plans. In this role, you will evaluate case files, resolve provider disputes, and...Remote work
- ...VitalConnect, Inc. is seeking a Denial Management Specialist on a fully remote basis to join the Revenue Cycle team. You will investigate complex third-party insurance denials and optimize reimbursement by researching and acting quickly on denials. The role requires 3...Remote work
$35.54 - $55.73 per hour
...Nurse Reviewer I Nurse Reviewer I Seeking RNs that have a current, unrestricted RN license in either the state of Illinois and/or California... ...department standards and performance metrics. Validating appeal requests. Manage appeal requests that come via email, fax,...Remote workFull timeWork experience placementWork at officeLocal areaMonday to FridayShift workWeekend workAfternoon shift- ...highly skilled subject matter specialists and operations executives, in... ...first and second level appeals of all denials in effort to overturn... ...Terminology, ICD-10, CPT and DRG knowledge a preferred,... ...Requirements: Work from home and remote location with a stable...Remote workWork experience placementWork at officeLocal areaWork from home
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