Pennsylvania Licensed Clinical Appeals Reviewer

VirtualVocationsMarietta, Georgia, 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 • Marietta, Georgia, United States

Related jobs

Promoted

Licensed Claims Adjuster

VirtualVocationsMarietta, Georgia, United States

Full-time

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...Show moreLast updated: 30+ days ago

Promoted

Claims Specialist - Primary Casualty

Axis CapitalAlpharetta, GA, United States

Full-time

This is your opportunity to join AXIS Capital - a trusted.We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders.We also ...Show moreLast updated: 30+ days ago

Promoted

Insurance Authorization Specialist

VirtualVocationsMarietta, Georgia, United States

Full-time

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...Show moreLast updated: 30+ days ago

Promoted
New!

Remote Prior Authorization Specialist

VirtualVocationsMarietta, Georgia, United States

Remote

Full-time

A company is looking for a Remote Prior Authorization Specialist.Key Responsibilities Manage outbound and occasional inbound calls to patients, providers, and payers Review and process prior aut...Show moreLast updated: 13 hours ago

Promoted

Claims Specialist

VirtualVocationsMarietta, Georgia, United States

Full-time

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...Show moreLast updated: 30+ days ago

Promoted

Workers' Compensation Claims Examiner

VirtualVocationsMarietta, Georgia, 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

Medicare Eligibility Representative

VirtualVocationsAlpharetta, Georgia, 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
New!

Grievance & Appeals Coordinator

VirtualVocationsMarietta, Georgia, United States

Full-time

A company is looking for a Grievance & Appeals Coordinator I.Key Responsibilities Analyze and resolve claims and authorization appeals from providers and formal grievances from members Prepare r...Show moreLast updated: 13 hours ago

Promoted
New!

Senior Medical Malpractice Adjuster

VirtualVocationsMarietta, Georgia, United States

Full-time

A company is looking for a Senior Resolution Specialist in Medical Malpractice for Long Term Care.Key Responsibilities Analyze coverage and settle complex claims within specialty areas Handle th...Show moreLast updated: 13 hours ago

Promoted

Complaint and Appeals Coordinator

VirtualVocationsMarietta, Georgia, United States

Full-time

A company is looking for a Coordinator, Complaint & Appeals (Remote).Key Responsibilities Reviews and processes appeals and grievances filed by patients Conducts internal audits and addresses co...Show moreLast updated: 30+ days ago

Promoted

Medicare Claims Specialist

VirtualVocationsMarietta, Georgia, United States

Full-time

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...Show moreLast updated: 30+ days ago

Promoted

Authorization Specialist

VirtualVocationsMarietta, Georgia, United States

Full-time

A company is looking for an Authorization Specialist to join their Patient Access-Registration team.Key Responsibilities Ensure accurate prior and ongoing authorizations by collecting demographic...Show moreLast updated: 30+ days ago

Promoted
New!

Tennessee Licensed Appeals Coordinator

VirtualVocationsMarietta, Georgia, United States

Full-time

A company is looking for an Appeals and Letters Coordinator remote position.Key Responsibilities : Process denial-related and member-oriented written communications in compliance with Federal and ...Show moreLast updated: 13 hours ago

Promoted

Life Insurance Case Manager

VirtualVocationsMarietta, Georgia, United States

Full-time

A company is looking for a Relationship Case Manager to manage life, LTC, and DI applications while facilitating communication between various stakeholders. Key Responsibilities : Review and proces...Show moreLast updated: 30+ days ago

Promoted

Subrogation Specialist

VirtualVocationsMarietta, Georgia, United States

Full-time

A company is looking for a UM Subrogation Specialist to manage collections and resolve disputed invoices.Key Responsibilities : Collect outstanding balances and provide necessary documentation Ne...Show moreLast updated: 30+ days ago

Promoted
New!

Missouri Licensed Prior Authorization Rep

VirtualVocationsMarietta, Georgia, United States

Full-time

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...Show moreLast updated: 14 hours ago

Promoted

Senior Claims Specialist - EPL / Fiduciary

Axis CapitalAlpharetta, GA, United States

Full-time

Promoted

Arizona Licensed Authorization Representative

VirtualVocationsMarietta, Georgia, United States

Full-time

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...Show moreLast updated: 30+ days ago

Promoted

Senior Claims Specialist

Axis CapitalAlpharetta, GA, United States

Full-time

Promoted

California Licensed Claims Specialist

VirtualVocationsAlpharetta, Georgia, United States

Full-time

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...Show moreLast updated: 30+ days ago