Pennsylvania Licensed Clinical Appeals Reviewer
VirtualVocationsKissimmee, Florida, United StatesHace 1 día
Tipo de contrato
- A tiempo completo
Descripción del trabajo
A company is looking for a Clinical Appeals Reviewer.
Key Responsibilities
Process appeals while ensuring compliance with regulatory milestones
Review medical records for documentation and billing code compliance
Engage with appellants, providers, and members to gather necessary information for case determination
Required Qualifications, Training, and Education
Bachelor's degree (BSN) required
3 or more years of experience in a related clinical setting
Current and unrestricted Registered Nurse (RN) licensure
Working knowledge of InterQual criteria preferred
Proficiency in utilizing Electronic Medical Records (EMRs) and MS Office
Crear una alerta de empleo para esta búsqueda
Clinical Reviewer • Kissimmee, Florida, United States
Ofertas relacionadas A company is looking for a Coordinator, P2P Appeals Management.Key Responsibilities Schedule Peer to Peer calls with payers and document information in the proprietary system Provide support for...Mostrar másÚltima actualización: hace 19 horas A company is looking for a Claims Specialist (PAWP).Key Responsibilities Adjust claims for assigned PAWP programs Build and maintain relationships with internal and external customers Investiga...Mostrar másÚltima actualización: hace más de 30 días A company is looking for a Claims Specialist to manage complex claims and ensure timely resolution.Key Responsibilities Manage a large inventory of complex claims to evaluate compensability and l...Mostrar másÚltima actualización: hace más de 30 días A company is looking for a Medicare Specialist to manage and resolve aged medical claims for hospital or physician groups.
Key Responsibilities Resolve cash generating accounts and review Medicare...Mostrar másÚltima actualización: hace más de 30 días A company is looking for a Claims Examiner, Medical Only.Key Responsibilities Investigate workers' compensation claims for medical care without lost wages Approve medical treatments, schedule ap...Mostrar másÚltima actualización: hace 2 días A company is looking for a Prior Authorization Specialist to manage the initiation and processing of prior authorization requests.
Key Responsibilities Initiate, process, and oversee clinical revi...Mostrar másÚltima actualización: hace más de 30 días A company is looking for a Health Claims Examiner I.Key Responsibilities Review medical documents to ensure completeness and validity for claim adjudication Determine covered services and calcul...Mostrar másÚltima actualización: hace 1 día A company is looking for an Insurance Specialist responsible for authorizing appointments and procedures.Key Responsibilities Identify patients requiring pre-certification or pre-authorization fo...Mostrar másÚltima actualización: hace más de 30 días A company is looking for a Patient Connection Authorization Associate to manage pre-certifications and authorizations for outpatient services.
Key Responsibilities Secure pre-certifications and au...Mostrar másÚltima actualización: hace 15 horas A company is looking for a PAS Pre-Service Authorization Representative to handle insurance authorization requests and verification.
Key Responsibilities Obtain and complete insurance authorizatio...Mostrar másÚltima actualización: hace 19 días A company is looking for a Prior Authorization Representative in Revenue Cycle Management.Key Responsibilities Validate patient information, scheduled tests / surgeries, and insurance details to en...Mostrar másÚltima actualización: hace 21 días A company is looking for a Licensing & Contracting / Commissions Specialist.Key Responsibilities Maintain and update contracting data and hierarchy information in the CMS Process contract paperwor...Mostrar másÚltima actualización: hace 21 horas 
Behavioral Health Court Coordinator.For over fifty years, Aspire Health Partners has been one of the leading non-profit behavioral health companies in the Southeast.
Serving nearly 40,000 clients pe...Mostrar másÚltima actualización: hace más de 30 días A company is looking for an Appeals Specialist II to support the documentation and processing of appeals, disputes, and reconsiderations.
Key Responsibilities Perform data entry to track, log, and...Mostrar másÚltima actualización: hace 11 horas A company is looking for a Clinical Trial Assistant (Remote & Full-Time).Key Responsibilities Maintain and manage the Trial Master File (TMF) for accuracy and inspection readiness Act as a prima...Mostrar másÚltima actualización: hace más de 30 días A company is looking for an Enrollment - Eligibility Representative.Key Responsibilities Research benefits, eligibility, and site of care for Medicare Part B members Communicate with doctor's of...Mostrar másÚltima actualización: hace 2 días A company is looking for a Claims Adjuster to manage and resolve claims effectively.Key Responsibilities Analyze claims exposure and execute decision-making to resolve claims Interact with vario...Mostrar másÚltima actualización: hace más de 30 días A company is looking for an Insurance Claims Specialist PB.Key Responsibilities Submits accurate and timely claims to third party payers Resolves claim edits and account errors prior to claim su...Mostrar másÚltima actualización: hace más de 30 días 
It's a great time to join AAA The Auto Club Group!.JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD.Claim Representative II (Florida PIP) - The Auto Club Group.
The Auto Club Group is seeking ...Mostrar másÚltima actualización: hace 5 días A company is looking for a Senior Claims Representative - Workers Compensation.Key Responsibilities Manage moderate to complex claims with minimal supervision Conduct thorough investigations, ev...Mostrar másÚltima actualización: hace 13 horas
- Oferta promocionada
- Nueva oferta
Peer to Peer Appeals Coordinator
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo
- Oferta promocionada
California Licensed Claims Specialist
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo
- Oferta promocionada
Claims Specialist
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo
- Oferta promocionada
Medicare Claims Specialist
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo
- Oferta promocionada
Workers' Compensation Claims Examiner
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo
- Oferta promocionada
Prior Authorization Specialist
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo
- Oferta promocionada
Health Claims Examiner
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo
- Oferta promocionada
Insurance Authorization Specialist
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo
- Oferta promocionada
- Nueva oferta
Patient Authorization Specialist
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo
- Oferta promocionada
Arizona Licensed Authorization Representative
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo
- Oferta promocionada
Missouri Licensed Prior Authorization Rep
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo
- Oferta promocionada
- Nueva oferta
Licensing and Commissions Specialist
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo
- Oferta promocionada
LMHC LCSW BEHAVIORAL HEALTH COURT
Aspire Health PartnersOrlando, FL, USA tiempo completo
- Oferta promocionada
- Nueva oferta
North Carolina Appeals Specialist
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo
- Oferta promocionada
Clinical Trial Assistant
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo
- Oferta promocionada
Medicare Eligibility Representative
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo
- Oferta promocionada
Licensed Claims Adjuster
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo
- Oferta promocionada
Insurance Claims Specialist
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo
- Oferta promocionada
Claim Representative II (Florida PIP)
The Auto Club GroupWinter Park, FL, United StatesA tiempo completo
- Oferta promocionada
- Nueva oferta
Wisconsin Licensed Claims Representative
VirtualVocationsKissimmee, Florida, United StatesA tiempo completo