Clinical Appeals Nurse

Join our dedicated team at HBiz where we strive to provide outstanding care and service excellence. We are currently seeking a highly skilled Clinical Appeals Nurse to play a crucial role in managing medical denials by providing clinical expertise in the appeals process. This position is ideal for those who excel in analytical thinking and have a strong...

UST is searching for an A&G USRN who will independently take customer support calls effectively and efficiently; follow the SOPs to complete the process and endeavor to resolve the issue, handle some escalated issues or escalate to a more knowledgeable person to resolve, in alignment with SLAs; and assists the Lead. In this role, you should independently be...

We are hiring Clinic NursesRoles and Responsibilities of Clinic Nurse:Provide quality care and assistance to patients and doctors in the clinics.Provides assistance and out-patient service to patients/ members.Administers basic medical services (e.g. nebulization, render emergency first aid, administration of r oral/injectable as per advice of physicians on...

UST is searching for an A&G USRN who will independently take customer support calls effectively and efficiently; follow the SOPs to complete the process and endeavor to resolve the issue, handle some escalated issues or escalate to a more knowledgeable person to resolve, in alignment with SLAs; and assists the Lead. In this role, you should independently be...

SUMMARYThe Clinical Denials Clinician of AR Management is responsible for recovering revenue through a.) intelligent and ethical investigation of disputed/denied clinical claims, b.) verifying eligibility for clinical review, and c.) preparation and documentation of appeals based on industry-accepted criteria. He / She is also relied on when it comes to...

Accesshealthcare is looking for REGISTERED NURSE to join our growing team.You'll be ensuring the completion of assigned patient cases by doing roll calls, processing concurrent and retro clinical reviews, work processing surgery authorizations, as needed.Qualifications : Must be Registered Nurse with Active licenseHospital Bedside experience (OR /ER / ICU/...

Responsibilities:Perform prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory and ancillary services Review, research, and prepare documentation related to retrospective review requests and appeals in accordance with local, state, and federal regulatory and designated accreditation (e.g., NCQA) standardsContact appropriate...

Accesshealthcare is looking for REGISTERED NURSE to join our growing team.You'll be ensuring the completion of assigned patient cases by doing roll calls, processing concurrent and retro clinical reviews, work processing surgery authorizations, as needed.Qualifications : Must be Registered Nurse with Active licenseHospital Bedside experience (OR /ER / ICU/...

Accesshealthcare is looking for REGISTERED NURSE to join our growing team.You'll be ensuring the completion of assigned patient cases by doing roll calls, processing concurrent and retro clinical reviews, work processing surgery authorizations, as needed.Qualifications : Must be Registered Nurse with Active licenseHospital Bedside experience (OR /ER / ICU/...

Primary Duties and Responsibilities: • Ensure that training and assessments happen as per statutory requirements. • Give feedback and coach trainees on key job capabilities. • Update and develop content as per client and business requirements. • Ensure that all relevant information is updated on to the MIS trackers regularly. • Conduct regular TNA...

Primary Duties and Responsibilities:• Ensure that training and assessments happen as per statutory requirements.• Give feedback and coach trainees on key job capabilities.• Update and develop content as per client and business requirements.• Ensure that all relevant information is updated on to the MIS trackers regularly.• Conduct regular TNA / TNI...

Primary Duties and Responsibilities:• Ensure that training and assessments happen as per statutory requirements.• Give feedback and coach trainees on key job capabilities.• Update and develop content as per client and business requirements.• Ensure that all relevant information is updated on to the MIS trackers regularly.• Conduct regular TNA / TNI...

Primary Duties and Responsibilities: • Ensure that training and assessments happen as per statutory requirements. • Give feedback and coach trainees on key job capabilities. • Update and develop content as per client and business requirements. • Ensure that all relevant information is updated on to the MIS trackers regularly. • Conduct regular TNA...

Purpose of Position: The Staff Nurse is primarily responsible for the efficient operation and proper maintenance of the center’s Nursing and Diagnostic department. They provide quality nursing care to all clients. The Staff Nurse works closely with the Clinic Manager and Senior Nurse Manager in ensuring both operational and Clinical standards are...

Primary Duties and Responsibilities: • Ensure that training and assessments happen as per statutory requirements. • Give feedback and coach trainees on key job capabilities. • Update and develop content as per client and business requirements. • Ensure that all relevant information is updated on to the MIS trackers regularly. • Conduct regular TNA...

Primary Duties and Responsibilities: • Ensure that training and assessments happen as per statutory requirements. • Give feedback and coach trainees on key job capabilities. • Update and develop content as per client and business requirements. • Ensure that all relevant information is updated on to the MIS trackers regularly. • Conduct regular TNA...

Primary Duties and Responsibilities: Ensure that training and assessments happen as per statutory requirements. Give feedback and coach trainees on key job capabilities. Update and develop content as per client and business requirements. Ensure that all relevant information is updated on to the MIS trackers regularly. Conduct regular TNA / TNI to ensure that...

The Clinical Denial Specialist writes and submits professionally written appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language. Appeals are submitted timely and tracked through final outcome.

Job Summary: This position performs audits of medical records on behalf of hospital clients for denial review, disallowed charges, and utilization reviews. This position requires critical thinking and judgment and must demonstrate the ability to appropriately use standard criteria such as InterQual and MCG in addition to criteria established by state...

Job Summary: This position performs audits of medical records on behalf of hospital clients for denial review, disallowed charges, and utilization reviews. This position requires critical thinking and judgment and must demonstrate the ability to appropriately use standard criteria such as InterQual and MCG in addition to criteria established by state...