Clinical Appeals Nurse - Medical Claims & Review
$30.5 - $59.47 per hourMolina Healthcare of Illinois
Molina Healthcare in Las Vegas is seeking a skilled Registered Nurse for clinical support in medical claim reviews. Responsibilities include conducting thorough reviews of medical claims and appeals, ensuring compliance with state and federal regulations while contributing to high-quality member care. Ideal candidates will have a minimum of 2 years in clinical nursing, strong analytical skills, and proficiency in coding systems like ICD-10 and CPT. This position offers a competitive hourly wage ranging from $30.50 to $59.47, depending on experience and qualifications. #J-18808-Ljbffr Molina Healthcare
$30.5 - $59.47 per hour
...Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment... ...procedures, and medically appropriate clinical guidelines. Contributes to overarching... ...:** + At least 2 years clinical nursing experience, including at least 1...MedicalClaimsHourly payWork experience placementWork at office$2,500 per month
...performance, and clinical expertise that builds... ...an efficient case review process through... ...providers, and other medical personnel.... ...accredited school of nursing and current unrestricted... ...Contractor (RAC) appeals. Experience... ...pre‑ and post‑pay claims reviews, and utilization...MedicalClaimsFull timeContract workPart timeFor contractorsShift work$45k
...Appeals Specialist for a Law Firm Billing Department Hooks, Meng & Clement (HMC) is seeking... ...who excels at managing insurance claim denials, drafting persuasive appeal letters... ...growing team. Responsibilities Review denied claims or underpaid claims Prepare...ClaimsWork at office- ...The role involves analyzing reimbursement trends, coordinating appeals with payers, and managing underpayment reconsiderations. Candidates should have over 2 years of experience in medical contracts and claims, as well as strong analytical skills. The position offers a...MedicalClaims
- An innovative firm offers an exciting telework opportunity for a Physician Reviewer. In this role, you will leverage your clinical expertise to review insurance appeals and claims, ensuring compliance with client policies and evidence-based guidelines. You will have the...MedicalRemote work
$19 - $25 per hour
...billing, insurance verification, and claims management, with a solid understanding... ...or denied claims Investigate and appeal claim denials Review patient bills for accuracy and completeness... ...Minimum 2 years of medical billing experience (mental health preferred...MedicalClaimsHourly payPart timeFlexible hoursAfternoon shift$17.98 - $32.12 per hour
...Requisition number: 2363526 Job category: Claims This position is Remote in Pacific,... ...: Processing and sending formal appeal responses to Providers / Clients Assist... ..., administrative, clerical, call center, medical claims, etc.) using computers as the primary...MedicalClaimsHourly payMinimum wageFull timeWork experience placementLive inWork at officeLocal areaRemote workMonday to FridayShift work$104k - $152.9k
...Assistant to manage the day-to-day clinical operational activities at the... ...with the Executive Director, Medical Director, and Assistant... ...manage workers' compensation claims. To expand clinic services... ...law, the university will review, on an individual basis, the...MedicalClaimsFull timeWork experience placementSeasonal workWork at officeMonday to Friday$70.56k - $110.88k
...Telephonic Nurse Case Manager I Location: This... ...necessary. Interfaces with Medical Directors and Physician... ...with providers, claims or service issues. Minimum... ...minimum of 3 years of clinical experience; or any... ...under Florida law should review the education and awareness...MedicalClaimsFull timeTemporary workWork experience placementWork at officeLocal areaMonday to Friday1 day per week$60k
...to hire an experienced Medical Billing Manager . This... ...engaging and energetic Clinic. Will be responsible for... ...unpaid and denied insurance claims. -Familiarity with... ...with secondary billing, appeals and contractual... ...any discrepancies. 3. Review the entire billing and...MedicalClaimsFull timePart timeWork at officeLocal area$30.5 - $59.47 per hour
...Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment... ...procedures, and medically appropriate clinical guidelines. Contributes to overarching... ...:** + At least 2 years clinical nursing experience, including at least 1...MedicalClaimsHourly payWork experience placementWork at office- ...mandated turnaround times. Our reviewers are compensated on a per-... .... JOB SUMMARY Utilizes clinical expertise, and reviews insurance appeals, prospective and retrospective claims. The Physician Reviewer will... ...provide an interpretation of the medical necessity of services...MedicalClaimsFor contractorsRemote work
- Supervisor, Telephonic Nurse Case Manager page is loaded##... ...and to perform clinical assessment and evaluate... ...worker’s compensation claims. The Supervisor will ensure... ...of appropriate medical treatment and length of... ...conducts monthly case reviews with team members.* Audits...MedicalClaims
- ...Medical Biller - Pain Management Clinic Location: Las Vegas, NV Employment Type: Full-Time, On-Site... ...ASC) billing and will ensure accurate claims submission, payment posting, and account... ...professional and ASC services. Review coding accuracy (CPT, ICD-10, modifiers...MedicalClaimsFull time
- ...clearance activities, including claims submission, accounts... ...problem-solving and supports appeals, denial management, and financial... ...may include data entry, claim review, charge review, accounts receivable... ...policies, coding, contracts, and medical records. Utilize subject...MedicalClaimsFull timeWork at office
$19 - $21 per hour
...entries Post private pay and Medicaid receipts into medical billing software and prepare/provide accounts... ...billed balances and past due amounts. Review and appeal assigned unpaid, denied, or underpaid claims for proper payment Qualifications Receivables...MedicalClaimsHourly payFull time- ...healthcare A state-of-the-art clinical and administrative... ...payments and resolve denied claims by initiating claims appeals and following escalation... ...payers, coordinating with the Medical Billers to correct and... ...claims for resolution. Reviews and corrects rejected electronic...MedicalClaimsHourly payMonday to FridayShift work
- ...clearance activities, including claims submission, accounts... ...problem-solving and supports appeals, denial management, and financial... ...may include data entry, claim review, charge review, accounts receivable... ...policies, coding, contracts, and medical records. Utilize subject...MedicalClaimsWork at office
$19 - $21 per hour
...entries. Post private pay and Medicaid receipts into medical billing software and prepare/provide accounts... ...accounts billed balances and past‑due amounts. Review and appeal assigned unpaid, denied, or underpaid claims for proper payment. Qualifications Minimum of two...MedicalClaimsFull timeShift work- ...remote position. Key Responsibilities Review and verify patients’ insurance coverage... ...coding departments to ensure accurate claims processing and reimbursement Investigate... ...required Previous insurance verification, medical office, or healthcare administrative...MedicalClaimsFull timeWork at office
$110 per hour
...to Psychiatric Mental Health Nurse Practitioners (PMHNPs) who hold... ...managing common psychiatric medication and treatment plans, and... ...no need to worry about unpaid claims No-show protection: Rula... ...You will: Provide clinical assessments for patients seeking...MedicalClaimsFor contractorsPrivate practice- ...entries. Post private pay and Medicaid receipts into medical billing software and prepare/provide accounts... ...accounts billed balances and past due amounts. Review and appeal assigned unpaid, denied, or underpaid claims for proper payment. Qualifications Minimum of two...MedicalClaimsFull time
$104k - $152.9k
...Environmental Medicine is seeking a Nurse Practitione r to manage the day-to-day clinical operational activities at the... ...closely with the Executive Director, Medical Director, and Assistant Director... ...To manage workers' compensation claims. To expand clinic services and...MedicalClaimsFull timeSeasonal workMonday to Friday- ...seeking a Patient Account Specialist in Las Vegas, NV. This role involves managing commercial medical insurance claims and ensuring timely payments. Key responsibilities include reviewing EOBs, following up on claims, and resolving discrepancies with insurance companies. The...MedicalClaims
- ...looking for a motivated, compassionate, and driven Pre-Litigation Claims Attorney to join our team! This position is ideal for an... ...regarding case status and treatment recommendations Review medical records, billing, and supporting documentation Work closely...MedicalClaims
$20.23 - $30.35 per hour
...related to prescriptions and medication resources or assistance programs... ...resolution to grievances and appeals issues. Responds to... ...PTCB Certification. Pharmacy claim adjudication experience.... ...screened under Florida law should review the education and awareness resources...MedicalClaimsFull timeTemporary workWork experience placementLocal areaImmediate startShift work1 day per week$35 per hour
As a multiline claims adjuster, you’ll have a vital role in keeping our claims process efficient... ...comparative negligence. You will need to review photos, video, and possibly conduct... ...settlement value of a claim, a review of medical records will be necessary. It will be...MedicalClaimsHourly payFull timeWork experience placementMonday to FridayFlexible hours$29.2k - $50.2k
...and resolve tickets related to disputes, claims, appeals, and shipment tracking within defined... ...accuracy and attention to detail when reviewing cases and updating systems Manage workload... ...) in addition to a full range of medical, financial, and/or other benefits (including...MedicalClaimsImmediate startRemote workVisa sponsorshipShift work$70.56k - $110.88k
...-06-04 Position Title: Nurse Case Manager I Job Description... .... Interfaces with Medical Directors and Physician... ...with providers, claims or service issues. Minimum... ...minimum of 3 years of clinical experience; or any combination... ...Florida law should review the education and awareness...MedicalClaimsFull timeContract workTemporary workWork experience placementWork at officeLocal areaMonday to FridayDay shift1 day per week$67k - $126k
...USD $67000.00 - $126000.00 Job Category: Claims Description The Senior Claims Specialist... ...Claims Team, using the latest technology to review, analyze and process claims that are... ...cause and origin experts and independent medical examiners. Refers to claim to subrogation...MedicalClaimsFull timeWork experience placementWork at officeLocal areaRemote work
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