Remote Registered Nurse - Claims & Appeals Quality Analyst
Compunnel Inc.
A healthcare solutions provider is seeking a Registered Nurse for Claims & Appeals Review. This remote role supports compliance and quality assurance in appeal reviews. Candidates should have a Bachelor's degree in healthcare and valid RN license in Florida. Key responsibilities include reviewing appeal cases, conducting audits, and collaborating with clinicians. This position offers the opportunity to work in a dynamic environment focusing on continuous improvement. #J-18808-Ljbffr
- ...Overview Job Title: Registered Nurse – Claims & Appeals Review Location: Remote (Anywhere in Florida) Duration: 06 Months/Can be Extended Working... ...: Negotiable Position Description The Quality Analyst is responsible for ensuring the accuracy, compliance...Remote workClaimsContract workDay shift
- Role Snapshot The Appeals Nurse examines medical records and claims information for first-level appeal cases to determine... .... Work Location We are open to remote work in the following approved... ...decision, are responded to within CMS quality and timelines standards. Minimum...Remote workClaimsContract workFor contractorsLocal areaImmediate start
- ...Health Solutions in Columbus, OH, is seeking an Appeals Nurse to review medical records and Medicare claims for first-level appeals to determine medical necessity... ..., and ensure compliance with CMS guidelines. A registered nurse with strong communication and attention to...Remote workClaims
- Health Business Solutions LLC is seeking a Clinical Appeals Nurse (RN) for a remote role. The position focuses on reviewing denied claims for clinical accuracy and medical necessity, developing appeal strategies, and drafting payer-ready documentation to overturn denials...Remote jobClaims
$36 - $40 per hour
...forging our own path. We’re a remote-first staffing and... ...coding career. If you are an Appeals and Denials Nurse looking for a new opportunity... ...representatives to resolve claim issues. Identifies, reviews... ...“Nurse” roles. Telehealth Registered Nurse- REMOTE September 202...Remote workClaimsPermanent employmentFull timeWork visa- R1 RCM, Inc. is seeking a Clinical Coding Appeals Nurse for a remote US-based role. You will review medical records and draft appeals for denied or underpaid claims, applying ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidance. Strong MS Office skills are essential for this...Remote jobClaims
$55 - $60 per hour
...Phaxis is looking for a dedicated Remote RN Grievance and Appeals Specialist in Manhattan where your contributions... ...: Examine why a service procedure or claim was reduced terminated or denied by... ...Review Entities). Track Quality Trends: Identify recurring claim denial...Remote workClaimsHourly payPermanent employmentContract workTemporary workMonday to Friday$95k - $110k
...talented individual for a DRG Nurse Reviewer Appeals and Hearings to coordinate... ...maintaining production goals and quality standards. Prepares case... ...perform reviews of multiple claim types to provide a flexible... ...expect in this role Remote (Work from Home) Up to 25...Remote workClaimsFull timeWork from homeRelocation packageFlexible hours$25 - $35 per hour
...is seeking a Clinical Appeals Nurse to join a leading... ...organization for a contract remote opportunity located in... ...necessary claim adjustments. • Identify... ...include: • Active Registered Nurse (RN) license in... ...regulatory compliance, quality improvement, benefit determinations...Remote workClaimsHourly payContract work- ...Clinical Appeals Specialist The Clinical Appeals Specialist completes... ..., medical policy and claims information along with corporate... ...appeal requests using nursing expert knowledge and all available... ...Licenses/Certifications: RN - Registered Nurse - State Licensure And/...Remote workClaimsWork at office
$70k - $80k
...Companies is seeking a Clinical Appeals Nurse for a fully remote healthcare-based... ...while facilitating necessary claim corrections and adjustments... ...Qualifications Active Registered Nurse (RN) license in the... ...Review, Grievance Resolution, Quality Assurance, Medicare,...Remote workClaimsLong term contract- ...Clinical Appeals Nurse Elevate Patient Financial Solutions has an exciting career opportunity... ...Appeals Nurse. This position will be remote work from home. The full-time schedule for... ...and appeals that are received after claim submission. Responsible for the management...Remote workClaimsFull timeWork from homeMonday to Friday
$45k - $70k
...Overview The Utilization Management Nurse Reviewer plays a crucial role... ..., control costs, and maintain quality care. \3 Key Responsibilities... ...and a media stipend for remote workspace. Company Commitment... ...process over 200,000 insurance claims annually for leading national...Remote workClaimsTemporary workWork at officeWork from home- Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To... ...operations by reviewing denied claims for clinical accuracy... ...Required Active Registered Nurse (RN) license in the... ...recovery contribution Quality and clarity of appeal documentation...Remote workClaims
$81.1k - $116.48k
Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote Join to apply for the Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist... .... The specialist may also handle clinical claim appeals from providers. This position is 10...Remote jobClaimsFull timeMonday to FridayShift work$73.35k - $113.25k
...The Payment Integrity Analyst (Team Lead) assists with... ...reviewing pre and post pay claim audits based on client,... ...of internal auditing, appeals of pre and post payment... ...record that requires quality review to determine... ...policies. This is a remote position. ESSENTIAL...Remote workClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaFlexible hours$65k - $116.75k
Remote, USA Remote, GA Remote, OH Remote, NC Remote, TN Remote... .... As our Clinical Coding Appeals Nurse , you will help review and... ...appeals of denied and underpaid claims. Every day you will review... ...Coder (CPC - AAPC) Active Registered Nurse is strongly preferred....Remote workClaimsFull timeLocal area- ...Job Description An employer is looking for a remote Appeals & Grievances Specialist who will be responsible for managing and resolving appeals and grievances related to dental insurance claims. This role requires strong analytical and communication skills, attention...Remote workClaimsWork at office
$46 per hour
...a RN Clinical Appeals Specialist Position... ...PA 19103 (Remote) As a RN... ...authorization history claims information... ...Apply clinical nursing knowledge... ...process improvement quality improvement provider... ...unrestricted Registered Nurse license... ...Industry Analysts (SIA 2024) One...Remote workClaimsHourly payFull timeContract workTemporary workFor contractorsWork experience placementWork at officeImmediate startWorldwideFlexible hours- ...Quality Analyst Review teams' production for errors and inaccuracies. Document and publish quality scores. Council and mentor team members... ...and AR follow-up. ~ Thorough understanding of provider claim life cycle. ~ Thorough knowledge of major insurance payers....Remote workClaims
- ...the substance of complex appeal or retrospective review... ...This is a full-time, remote (40-hours/week) working... ...information to identify quality of care issues. To... ...Accredited School of Nursing Required Skills and... ...management skills. Knowledge of claims systems. Presentation...Remote workClaimsFull timeFor contractorsWork experience placementWork at officeLocal areaMonday to FridayShift work
- ...seeks a detail-oriented medical billing assistant to help prepare and submit appeals, review EOBs, and ensure accurate CPT/ICD coding under guidance. The role supports workers’ compensation claim processing and a broad range of billing tasks. This position favors a...Remote workClaimsHome office
- ...Utilization Management Department (Fully Remote) Provides health care services regarding admissions, case management, discharge... ...records/documentation, precertification, reimbursement and claim denials/appeals. Assesses and coordinates discharge planning needs with...Remote workClaims
- ...Phothera is seeking a Denials & Appeals Specialist to own the appeals process for denied and underpaid claims, focusing on medical necessity and payer policy alignment to... ...reimbursement and patient access. While the role is fully remote, candidates based in or near Beachwood, OH are...Remote workClaims
- ...Description Medicaid Business / QA Analyst ~7–12+ Month Contract | Remote | No ThirdParty Firms | Medicaid... ...data and processes while performing quality assurance testing within a large-scale... ...program knowledge—eligibility, claims, encounters, provider enrollment, managed...Remote workClaimsContract work
- ...Job Title: Quality Analyst (Backend / Database / EDW / ETL Testing) Location: Primarily Remote Duration: 12 Months Functional Description: We are... ...experience (commercial, Medicaid and Medicare claims data, EDI X12 transactions in the...Remote workClaims
- ...Registered Nurse: Review and EvaluationAre you a registered nurse ready... ...Join Pennsylvania's premier Quality Improvement Organization and... ...setting to review and audit claims, support program integrity initiatives... ...letters, reason codes, and appeal rights in compliance with...Remote workClaimsFull timeTemporary workWork at officeWork from home
$81.4k - $145k
...organization, apply now.We are currently seeking a Quality Analyst to join our team in Montgomery, Alabama... ...in Montgomery Alabama. This can be a remote position with limited travel to the... ...in Medicaid domain knowledge related to Claims processing and preferably claims data...Remote workClaimsTemporary workFor contractorsWork experience placementWork at officeFlexible hours- ...Member Appeals Coordinator Will the position be 100% remote? Yes. Are there any specific location requirements? No. Are there time zone requirements? Prefer... ...and/or regulatory timelines are met. Research claims appeals and grievances using support systems to determine...Remote workClaimsContract work
$22.74 - $27.79 per hour
...Appeals Specialist Remote (WFH) At Adaptive, we're Powering the Age of Immune Medicine. Our goal is to harness the power of the adaptive immune... ...Appeals Specialist is responsible for managing insurance claim appeals to ensure proper reimbursement for molecular and...Remote workClaimsHourly payWork at officeWork from homeHome officeNight shift
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