Clinical Appeals Specialist

Clinical Appeals Specialist (Registered Nurse)Our partner in the BPO industry is looking for Clinical Appeals Writers to help navigate the complexities of medical claim denials and ensure fair resolutions for patients and providers.100% Remote – Work from anywhereDay Shift Hours – Enjoy a consistent scheduleWhat You'll Do:Prepare and Submit Clinical...

Clinical Appeals Nurse Specialist Role OverviewAt Omega Healthcare Management Services Inc., we seek a highly skilled Clinical Appeals Nurse Specialist to join our team. As a Clinical Appeals Nurse Specialist, you will be responsible for reviewing and resolving insurance claim denials in a timely and effective manner.This role requires strong clinical...

Appeals Writer - Clinical DenialsWe are seeking an Appeals Writer - Clinical Denials to join our team at Viventis Search Asia. The successful candidate will work closely with our partner in the BPO industry to resolve medical claim denials.About the Job:Appeals Writing: Craft persuasive appeals that address specific issues and regulations, ensuring the...

Company Overview:AGS Health is a leading healthcare provider that delivers exceptional patient care and services.We are seeking a highly skilled Clinical Healthcare Appeals Specialist to join our team.About the Role:This position is responsible for reviewing and appealing denied medical claims on behalf of our clients.The ideal candidate will have experience...

QualificationsPH Registered Nurse with experience in doing medical necessity appeals, lack of authorization appeals.Clinical authorization experience is preferred, but appeals experience is required.Proficient in reading Explanation of Benefits (EOB) and investigating denial root causes.Must be skilled in navigating various payer and provider portals.Typing...

JOB SUMMARYResponsible for validating dispute reasons following Explanation of Benefits (EOB) review, escalating payment variance trends or issues to NIC management, and generating appeals for denied or underpaid claims.ESSENTIAL DUTIES AND RESPONSIBILITIESValidate denial reasons and ensure coding in DCM is accurate and reflects the denial reasons....

Job Description:AGS Health is a dynamic and fast-paced organization that requires a skilled Clinical Healthcare Appeals Specialist to join our team. As a key member of our team, you will be responsible for reviewing and appealing denied medical claims on behalf of our clients.This role involves working closely with our clinical team to ensure that our...

Medical Appeals Specialist with Interqual ExpertiseWe are looking for a highly skilled Medical Appeals Specialist to join our team at Omega Healthcare Management Services Inc. As a Medical Appeals Specialist, you will be responsible for reviewing and appealing insurance claim denials related to medical necessity and authorization.Your primary responsibility...

Access Healthcare Services is seeking an experienced Clinical Denial Specialist to join our growing team. In this role, you'll be responsible for performing advanced level work related to clinical denial and utilization management. This includes managing medical denials through comprehensive reviews of clinical documentation, handling audit/compliance...

Access Healthcare is looking for a Utilization and Clinical Denials Nurse to join our growing clinical account. The ideal candidate is a Licensed Philippines Nurse with at least one (1) year of hospital bedside experience and a strong understanding of utilization review, clinical documentation, and denial management in a BPO set-up. This role involves...

About the Role:The Clinical Utilization Review Specialist will be responsible for conducting retrospective, concurrent, and prospective reviews of inpatient, outpatient, ambulatory, and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service, and level of care.This role will also involve reviewing and researching...

Job Description:The Clinical Validator Specialist role at Omega Healthcare Management Services Inc. involves working with healthcare professionals to ensure the accuracy and integrity of clinical data. As a specialist in this field, you will be responsible for reviewing and validating clinical information to ensure it meets the required standards.A minimum...

**Job Description:**We are seeking a skilled Clinical Authorization Specialist to join our team at AGS Health. As a key member of our revenue cycle management team, you will play a crucial role in verifying patient insurance eligibility, benefits, and requirements.**Responsibilities:Contact insurance carriers to verify patient insurance eligibility,...

Job Overview:We are seeking a highly motivated and organized individual to join our team as a Clinical Authorization Specialist. In this role, you will be responsible for reviewing authorization requests from servicing providers and making clinical determinations based on submitted clinical documents.Key Responsibilities:Receives additional clinical...

We are seeking a skilled Clinical Documentation Improvement (CDI) Specialist to join our team at GGIS Services. As a CDI Specialist, you will play a crucial role in ensuring the accuracy and completeness of patient records.Key Responsibilities:Review and analyze clinical documentation to ensure accurate reflection of patient careDevelop and submit clear,...

Clinical Performance Support Specialist Needed!Tenet Global Business Center, Inc. is seeking a skilled Clinical Performance Support Specialist to support our clinical teams and ensure compliance with regulatory requirements.The successful candidate will have a strong background in medical terminology, clinical experience, and excellent analytical and...

Job Profile: Clinical Site Payment SpecialistPosition Summary: The Clinical Site Payment Specialist is responsible for ensuring timely and accurate payment processes for clinical trial sites. This role involves coordination with various stakeholders, including clinical research organizations (CROs), sponsors, and site personnel, to manage financial...

MicroSourcing International, Inc. is seeking a highly organized and detail-oriented Clinical Task Specialist to join our team. As a key member of our healthcare operations department, you will play a crucial role in ensuring the timely completion of clinical tasks across departments via electronic health records (EHR).The successful candidate will have...

PRODUCT & CLINICAL SPECIALIST (MEDICAL IMAGING)QUALIFICATIONSMedical Allied graduate – must be licensed radiologic technologist.Minimum of 3 years of clinical experience as a general imaging or sonographer with experience in commercial clinical sales.Sales experience in the healthcare industry is a plus.Clinical product specialist include a bachelor's...

KMC Solutions is a leading provider of innovative healthcare solutions. We are seeking a Clinical Support Specialist to join our team as a RN. In this role, you will be responsible for providing clinical support to patients with chronic conditions.As a Clinical Support Specialist, you will develop and implement personalized care plans, conduct routine...