Talent.com
Pennsylvania Licensed Clinical Appeals Reviewer

Pennsylvania Licensed Clinical Appeals Reviewer

VirtualVocationsMinneapolis, Minnesota, United States
14 hours ago
Job type
  • Full-time
Job description

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

Create a job alert for this search

Clinical Reviewer • Minneapolis, Minnesota, United States

Related jobs
  • Promoted
  • New!
Texas Licensed Insurance Associate

Texas Licensed Insurance Associate

VirtualVocationsSaint Paul, Minnesota, United States
Full-time
A company is looking for a Property and Casualty Insurance Associate - Sales / Telesales (Remote).Key Responsibilities Provide accurate and timely responses to customer inquiries regarding travel i...Show moreLast updated: 10 hours ago
  • Promoted
Remote Legal Administrative Assistant

Remote Legal Administrative Assistant

VirtualVocationsSaint Paul, Minnesota, United States
Remote
Full-time
A company is looking for a Remote Legal Administrative Assistant.Key Responsibilities Providing administrative support to the firm Assisting in handling communications with clients and co-counse...Show moreLast updated: 1 day ago
  • Promoted
Litigation Associate Attorney

Litigation Associate Attorney

Larkin HoffmanMinneapolis, MN, US
Full-time
Larkin Hoffman is seeking to add a Litigation Associate Attorney to join our Firm.This successful candidate will work closely with our current real estate litigation attorneys to support clients in...Show moreLast updated: 30+ days ago
  • Promoted
New York Licensed Staff Counsel

New York Licensed Staff Counsel

VirtualVocationsSaint Paul, Minnesota, United States
Full-time
A company is looking for a Staff Counsel II.Key Responsibilities Independently represents the Insured in court and presents witnesses and evidence on litigated claims Analyzes complex legal issu...Show moreLast updated: 1 day ago
  • Promoted
California Licensed Claims Examiner

California Licensed Claims Examiner

VirtualVocationsMinneapolis, Minnesota, United States
Full-time
A company is looking for a Workers Compensation Claims Examiner III (Temporary).Key Responsibilities Manage a caseload of 150 to 180 workers' compensation files, including complex claims Conduct...Show moreLast updated: 30+ days ago
  • Promoted
Eligibility Specialist

Eligibility Specialist

VirtualVocationsSaint Paul, Minnesota, United States
Full-time
A company is looking for an Eligibility Specialist to manage and maintain accurate eligibility and enrollment records for health and welfare benefit plans. Key Responsibilities : Process eligibilit...Show moreLast updated: 30+ days ago
  • Promoted
Remote Medical Insurance Verifier

Remote Medical Insurance Verifier

VirtualVocationsSaint Paul, Minnesota, United States
Remote
Full-time
A company is looking for a Remote Medical Insurance Verification Specialist.Key Responsibilities Assist patients with obtaining coverage for prescription medications Make inbound / outbound calls ...Show moreLast updated: 1 day ago
  • Promoted
Workers' Compensation Claims Examiner

Workers' Compensation Claims Examiner

VirtualVocationsMinneapolis, Minnesota, United States
Full-time
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...Show moreLast updated: 30+ days ago
  • Promoted
  • New!
Stop Loss Claims Coordinator

Stop Loss Claims Coordinator

VirtualVocationsMinneapolis, Minnesota, United States
Full-time
A company is looking for a Stop Loss Filing Coordinator to manage the end-to-end stop loss claims process.Key Responsibilities : Prepare and submit stop-loss claims and supporting documentation A...Show moreLast updated: 12 hours ago
  • Promoted
Senior Claims Examiner

Senior Claims Examiner

VirtualVocationsMinneapolis, Minnesota, United States
Full-time
A company is looking for a Senior Claims Examiner to adjudicate complex life insurance claims.Key Responsibilities Lead the adjudication of complex or contested life insurance claims Conduct tho...Show moreLast updated: 30+ days ago
  • Promoted
Chief Counsel, Blockchain Network

Chief Counsel, Blockchain Network

VirtualVocationsMinneapolis, Minnesota, United States
Full-time
A company is looking for a Chief Counsel for the Arc Blockchain Network.Key Responsibilities Advise on the design, launch, and governance of the Arc Network to ensure legal and regulatory complia...Show moreLast updated: 1 day ago
  • Promoted
Regulatory Counsel

Regulatory Counsel

VirtualVocationsSaint Paul, Minnesota, United States
Full-time
A company is looking for a Regulatory Counsel to join their legal team remotely.Key Responsibilities Research, interpret, and summarize state-specific regulations related to litigation support D...Show moreLast updated: 30+ days ago
  • Promoted
Medicare Eligibility Representative

Medicare Eligibility Representative

VirtualVocationsSaint Paul, Minnesota, United States
Full-time
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...Show moreLast updated: 1 day ago
  • Promoted
Michigan Licensed Claims Adjuster

Michigan Licensed Claims Adjuster

VirtualVocationsSaint Paul, Minnesota, United States
Full-time
A company is looking for a Senior Workers Compensation Claims Adjuster.Key Responsibilities Execute decision-making to analyze and resolve claims while managing claims exposure Interact with var...Show moreLast updated: 30+ days ago
  • Promoted
  • New!
Licensed Claims Analyst

Licensed Claims Analyst

VirtualVocationsMinneapolis, Minnesota, United States
Full-time
A company is looking for a Claims Analyst to join their team in a remote capacity.Key Responsibilities Provide exceptional resolution of claim files to ensure a best-in-class claims experience I...Show moreLast updated: 4 hours ago
  • Promoted
  • New!
Workers' Compensation Claims Adjuster (FL, RI, TX Licensed)

Workers' Compensation Claims Adjuster (FL, RI, TX Licensed)

VirtualVocationsSaint Paul, Minnesota, United States
Full-time
A company is looking for a Workers' Compensation Claims Adjuster to manage complex claims in various jurisdictions across the United States. Key Responsibilities Adjudicate higher complexity worke...Show moreLast updated: 10 hours ago
  • Promoted
  • New!
Pennsylvania Licensed Clinical Appeals Reviewer

Pennsylvania Licensed Clinical Appeals Reviewer

VirtualVocationsSaint Paul, Minnesota, United States
Full-time
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 billin...Show moreLast updated: 14 hours ago
  • Promoted
ABA Intake Admin Assistant

ABA Intake Admin Assistant

VirtualVocationsSaint Paul, Minnesota, United States
Full-time
A company is looking for an ABA Intake & Authorizations Admin Assistant - Spanish Speaking.Key Responsibilities Facilitate the client onboarding process and ensure accurate documentation and comm...Show moreLast updated: 1 day ago
  • Promoted
Arizona Licensed Workers' Comp Adjuster

Arizona Licensed Workers' Comp Adjuster

VirtualVocationsSaint Paul, Minnesota, United States
Full-time
A company is looking for a Senior Claims Examiner I responsible for examining, investigating, and settling insurance claims efficiently. Key Responsibilities Investigate workers' compensation clai...Show moreLast updated: 1 day ago
  • Promoted
Insurance Information Coordinator

Insurance Information Coordinator

VirtualVocationsSaint Paul, Minnesota, United States
Full-time
A company is looking for an Insurance Information Coordinator - Remote.Key Responsibilities Verify member benefits, claims, and appeal information with insurance companies Research claims and in...Show moreLast updated: 30+ days ago