Remote IBR Clinical Appeals Reviewer
University of Minnesota School of Nursing
- Remote job
UnitedHealth Group seeks an experienced Clinical Appeals Reviewer for the Itemized Bill Review (IBR) team. The role analyzes appeals, reviews medical records, and drafts written responses with coding and auditing expertise. Remote work within the U.S. is available, with standard 8:00am–5:00pm hours and potential overtime. Responsibilities include resolving Level 1–3 appeals, identifying overpayments, and ensuring compliance with CPT/NCCI and ICD-10 coding. #J-18808-Ljbffr University of Minnesota School of Nursing
$69.8k - $125.9k
HCSC is seeking a dedicated RN to facilitate member and provider appeals, coordinating with Medical Directors and Customer Service to... ...abilities and a solid foundation in healthcare operations. This remote position supports the U.S. market. Compensation ranges from $69...Remote job$45 per hour
SPECTRAFORCE is seeking a Clinical Appeals Specialist to handle member-generated appeal processes remotely from California. The role involves reviewing medical records and ensuring compliance with clinical policies. Ideal candidates will have strong managed care and clinical...Remote jobHourly pay- ...Point32Health, Inc. is seeking an Appeals and Grievance Coordinator to manage day-to-day tasks within the A&G department. You will process mail, assign cases, and support analysts while ensuring compliance with regulatory timelines. The role requires 1-2 years of relevant...Remote workWork from home
$35 - $63 per hour
...Caring. Connecting. Growing together. The Itemized Bill Review (IBR) Clinical Appeals Reviewer will analyze and respond to client and/or hospital... ...or weekends. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough...Remote jobHourly payMinimum wageFull timeWork experience placementLive inLocal areaMonday to Friday- Dane Street is seeking a Clinical Pharmacy Reviewer (Pharmacist) to evaluate complex prior authorization requests, appeals, and medication coverage determinations in a remote setting. The role applies evidence-based guidelines, formulary management, and Drug Utilization...Remote job
$28.37 - $39.19 per hour
...through technology, services, and clinical expertise. Our mission is to... ...Health is looking for a Clinical Reviewer - Arkansas Behavioral Health License (Remote within Arkansas) to join our growing... ...Providers on the Reconsideration and Appeal process. Read, understand, and...Remote workContract workWork at officeLocal areaMonday to FridayFlexible hours- ...healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member... ...clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental... ...practice and knowledge of Utilization Review Guidelines. The position offers a competitive...Remote work
- ...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 requires residence...Remote jobWork at officeWork from home
- The Clinical Pharmacy Reviewer (Pharmacist) evaluates complex prior authorization requests, appeals, and medication coverage determinations to ensure clinical appropriateness and... ...Benefits Why Join Dane Street? Collaborative remote culture Professional growth opportunities...Remote jobLocal areaWork from home
$88.7 - $140 per hour
Acentra Health in McLean, Virginia is seeking a Physician Medical Reviewer to join their team. The role involves conducting independent... ...candidate will have an M.D. or D.O. degree, with at least 3 years of clinical practice and experience in Utilization Review. Acentra Health...Remote jobHourly pay- ..., trend identification for assigned clinical outcomes, and present this data at the... .... Assist with retrospective reviews and preparation of appeals as indicated. Facilitate peer review... ...is for CaroMont Health care system. Remote work may be approved per Manager/Director...Remote work
- ...Solutions in Georgia is seeking a Grievance & Appeals Coordinator I to manage the grievance and... ...in a regulated environment. You will review, process and coordinate cases across... ...outcomes. This hybrid role offers office and remote work, standard business hours, and benefits...Remote workWork at office
- ...in the community? Do you enjoy using your clinical expertise to evaluate needs, support care... ...the right time? In this role, you will review clinical documentation to determine... ...positioned for success on this team. This is a remote position based in Oregon and travel is...Remote workFull timeContract workWork from home
$100.16k - $218.72k
...our client, we are seeking a Clinical Documentation Integrity Specialist... ..., preparing evidence-based appeals, and promoting continuous... ...documentation practices. Location: Remote - US based candidates only,... ...18 annually Responsibilities Review high-acuity patient records...Remote workVisa sponsorshipMonday to Friday- ...RN Clinical Appeals Reviewer- Utilization Management Location: METROHEALTH MEDICAL CENTER Biweekly Hours: 80.00 Shift: 7a-330p The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well...Shift work
$22.74 - $27.79 per hour
...Appeals Specialist Remote (WFH) At Adaptive, we're Powering the Age of Immune Medicine. Our goal... ...Functions Appeal Submission Review denied claims and determine appropriate... ..., prior authorization details, clinical justification). Ensure appeals are...Remote workHourly payWork at officeWork from homeHome officeNight shift- ...Phothera is seeking a Denials & Appeals Specialist to own the appeals process for denied and underpaid claims, focusing on medical necessity... ...reimbursement and patient access. While the role is fully remote, candidates based in or near Beachwood, OH are strongly...Remote work
- ...Managing appeals cases, the full-time Appeals Specialist II will review documentation, communicate resolutions, and coordinate with departments to ensure compliance in a remote work environment. Key responsibilities Manage appeals cases and document all actions taken...Remote workFull time
- ...Researching and responding to inquiries from various stakeholders, the full-time Appeals Specialist will manage the appeals/dispute process remotely, ensuring timely and accurate customer service and resolution of issues. Key responsibilities Provides customer service...Remote workFull timeContract workFor contractorsWork at office
$93.35k - $132.43k
...First (Days) Overview: Sentara Health Plans is hiring a Clinical Claims Reviewer/ RN - Remote! Status: Full-time, permanent position (40 hours)... ...-105056 Talroo - Nursing Clinical Claims Reviewer, Appeals, Denials, Utilization management, Registered Nurse, BSN,...Remote workPermanent employmentFull timeTemporary workWork at officeShift work- ...Member Appeals Coordinator Will the position be 100% remote? Yes. Are there any specific location requirements? No. Are there time zone requirements? Prefer... .../mouse, headset. Job Summary: Responsible for reviewing and resolving member and provider complaints and communicating...Remote workContract work
- ...Job Title: Appeals Specialist II - J00909 Address: Various, MI 99999 Job Description Manage... ...appeals efficiently and accurately. Review and analyze case documentation to determine... .... Critical Information Shift hours vary; remote and on-site options available. Remote work...Remote workFull timeWork at officeShift work
$28 - $35 per hour
...Location: Remote (U.S.) Preferred Location: Candidates based in... ...opportunity for a Denials & Appeals Specialist. This is a remote... ...FDA-approved indications and clinical evidence supporting home UV... ...& Appeals Management Review, analyze, and prioritize denied...Remote workHourly payWork at officeLocal area- ...Managing the full life cycle of member and provider appeals and grievance cases, the full-time Appeals and Grievance Specialist will... ...investigation, and documentation to ensure timely resolution while working remotely. Key responsibilities Research and analyze case documentation...Remote workFull timeWork at office
- ...Clinical Documentation Improvement Specialist Make your clinical expertise count — beyond... ...to the world. What You'll Do: Review inpatient medical records concurrently... ...management with clinical justifications for appealed claims Collaborate with coding teams...Remote work
- ...experienced Registered Nurse to facilitate member and provider appeals and ensure processes meet guidelines and audit standards. You will... ...experience, and knowledge of managed care. This is a remote/work-from-home position with standard CST hours and occasional...Remote jobWork from homeShift work
$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- ...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
- ...Member Appeals Specialist Primary responsibilities would include triaging incoming appeals/grievances, categorizing them appropriately... ...of record, making edits necessary for the case at hand Reviewing the appeal request to determine if additional medical records are...Remote workTraineeship
- ...Job Description An employer is looking for a remote Appeals & Grievances Specialist who will be responsible for managing and resolving... ...internal teams and external stakeholders. Key Responsibilities Review, research, and process appeals and grievances in compliance...Remote workWork at office
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