We have other current jobs related to this field that you can find below
-
RN-Appeals and Denials
4 weeks ago
Remote, Oregon, United States SSM Health Full timeIt's more than a career, it's a callingMO-REMOTEWorker Type:RegularJob Highlights:Department: Care CoordinationSchedule: Full Time, Day Shift, 8:00am-4:30pm; No WeekendsStarting Pay: $67, (Offers are based on years of experience and equity for this role.)Location: Remote**Candidate must live in IL, MO, OK, or WI. If living in MO, OK, or WI, must have...
-
Denials Operations Expert
4 weeks ago
Remote, Oregon, United States The Wilshire Group Full timeWilshire hires only the brightest and most experienced professionals in the healthcare revenue cycle management industry. Wilshire will take the time to get know you and your employment history. We will then place you in a role that will lead to a path of career success. Job Description: Denials Operations ExpertLocation: Remote (PST hours)Travel:...
-
Appeals Specialist II
2 months ago
Remote, Oregon, United States Healthcare Management Administrators (HMA) Full timeHMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. We are proud to say that for three years, HMA has...
-
PFS Analyst
2 weeks ago
Remote, Oregon, United States Central Maine Medical Center Full timeAt Central Maine Healthcare our team members are committed to providing exceptional care and experiences for our community and for each other every day. Position Summary: Responsible for informing and supporting the strategic and operational leadership of the Patient Financial Services (PFS) Department. Contributes to the financial strength, compliance, and...
-
Sr Tax Accountant, Tax, FT, 08:30A-5P
1 month ago
Remote, Oregon, United States Baptist Health South Florida Full timeBaptist Health South Florida is the region's largest not-for-profit healthcare organization with 12 hospitals, more than 27,000 employees, 4,000 physicians, and 200 outpatient centers, urgent care facilities, and physician practices spanning across Miami-Dade, Monroe, Broward, and Palm Beach counties. Baptist Health has internationally renowned centers of...
-
Clinical Appeals Analyst
1 month ago
Remote, Oregon, United States Piper Companies Full timePiper Companies is currently seeking a Clinical Appeals Analyst for a remote opportunity within a highly accredited health insurance organization to complete the analysis, research, and completion of complex appeals. Responsibilities of the Clinical Appeals Analyst:Assess, analyze, and complete non-routine appeals and grievance in order to ensure customer...
-
Coding Edit
2 weeks ago
Remote, Oregon, United States Driscoll Children's Hospital Full timeWhere compassion meets innovation and technology and our employees are family. Thank you for your interest in joining our team Please review the job information below. General Purpose of Job:Ensures that coding compliance initiatives are met with all record types. Reviews and analyzes medical records, CPT, ICD-10 data submitted by the coding and charge entry...
-
QIC Appeals Specialist
4 days ago
Remote, Oregon, United States Maximus Full timeJob Title: Coordinator 2 - Appeals QIC (remote) Company: Maximus QIC Appeals Location: Remote, United States Employment Type: Full-time Overview: As a vital member of our team, the Coordinator 2 will serve as a Subject Matter Expert in designated process areas, ensuring the integrity and accuracy of data related to Independent Medical...
-
Billing Specialist- Discharge
2 months ago
Remote, Oregon, United States Midi Health Full timeMidi is on a mission to bring compassionate, high-quality medical care to women 40+. We center the healthcare needs and experiences of women in this unique life stage because we're founded by women who are living it, too.Who we are:Midi Health is the only comprehensive virtual care clinic for women in midlife navigating perimenopause, menopause, and other...
-
Utilization Management Specialist
2 months ago
Remote, Oregon, United States Equip Full timeAbout Equip Equip is the leading virtual, evidence-based eating disorder treatment program on a mission to ensure that everyone with an eating disorder can access treatment that works. Created by clinical experts in the field and people with lived experience, Equip builds upon evidence-based treatments to empower individuals to reach lasting recovery. All...
-
Remote, Oregon, United States Baptist Health South Florida Full timeBaptist Health South Florida is the region's largest not-for-profit healthcare organization with 12 hospitals, more than 27,000 employees, 4,000 physicians, and 200 outpatient centers, urgent care facilities, and physician practices spanning across Miami-Dade, Monroe, Broward, and Palm Beach counties. Baptist Health has internationally renowned centers of...
-
Channel Sales Manager
1 month ago
Remote, Oregon, United States Guidewire Software Full timeGuidewire is seeking a dynamic and experienced Channel Sales Manager to oversee and expand our ISV reseller channel for HazardHub with API, the most comprehensive set of property risk data, casualty risk data, and hazard risk scoring in the P&C insurance industry. The ideal candidate will have a strong background in channel sales management, with a proven...
-
Revenue Cycle Specialist
1 month ago
Remote, Oregon, United States Equip Full timeAbout Equip Equip is the leading virtual, evidence-based eating disorder treatment program on a mission to ensure that everyone with an eating disorder can access treatment that works. Created by clinical experts in the field and people with lived experience, Equip builds upon evidence-based treatments to empower individuals to reach lasting recovery. All...
-
RN-Utilization Review
2 months ago
Remote, Oregon, United States SSM Health Full timeIt's more than a career, it's a callingWI-REMOTEWorker Type:RegularJob Highlights:Department: Utilization ReviewSchedule: Full Time, Day Shift, 8:30am-5:00pm; every 3rd weekend rotationStarting Pay: $67, annually (Offers are based on years of experience and equity for this role.)Location: WI Remote (candidate must live in IL, MO, OK, or WI)Candidate...
-
RN-Utilization Review
2 months ago
Remote, Oregon, United States SSM Health Full timeIt's more than a career, it's a callingMO-REMOTEWorker Type:RegularJob Highlights:Department: Utilization ReviewSchedule: Full Time, Day Shift, 8:00am-4:30pm; no weekendsStarting Pay: $67, annually (Offers are based on years of experience and equity for this role.)Location: Remote (candidate must live in IL, MO, OK, or WI)Candidate must have inpatient...
-
Revenue Cycle Manager
1 month ago
Remote, Oregon, United States Cayaba Care Full timeAbout Cayaba CareOur mission is to improve outcomes in underserved communities by reimagining how maternity care is delivered. Our team is focused on building technology-enabled solutions to deliver comprehensive clinical and non-clinical maternity services in-home or in-office. Our Values:Healthcare is Human: We partner with the communities we serve to...
-
RN-Utilization Review
2 months ago
Remote, Oregon, United States SSM Health Full timeIt's more than a career, it's a callingWI-REMOTEWorker Type:RegularJob Highlights:Department: Utilization ReviewSchedule: Part Time, Day Shift, 8:30am-5:00pm; every 3rd weekend rotationStarting Pay: $32.58+ (Offers are based on years of experience and equity for this role.)Location: WI Remote (candidate must live in IL, MO, OK, or WI)Candidate must...
-
RN-Utilization Review
4 weeks ago
Remote, Oregon, United States SSM Health Full timeIt's more than a career, it's a callingWI-REMOTEWorker Type:RegularJob Highlights:Department: Utilization ReviewSchedule: Full Time, Day Shift, 8:30am-5:00pm; every 3rd weekend rotationStarting Pay: $67, (Offers are based on years of experience and equity for this role.)Location: Remote (candidate must live in IL, MO, OK, or WI)**If living in MO, OK,...
-
Social Media Coordinator
1 month ago
Remote, Oregon, United States Advancing Eco Agriculture Full timeDescriptionAbout the CompanyAdvancing Eco Agriculture is a leading company in the regenerative agriculture industry, dedicated to improving the health of our planet and the quality of our food. We develop and promote innovative crop nutrition products and consulting services that help farmers increase yields, improve crop quality, and regenerate their...
-
Remote, Oregon, United States Baptist Health South Florida Full timeBaptist Health South Florida is the region's largest not-for-profit healthcare organization with 12 hospitals, more than 27,000 employees, 4,000 physicians, and 200 outpatient centers, urgent care facilities, and physician practices spanning across Miami-Dade, Monroe, Broward, and Palm Beach counties. Baptist Health has internationally renowned centers of...
Denial & Appeals Coordinator, RN, Concurrent Denials Prevention, FT, 08:30A-5P
3 months ago
Baptist Health South Florida is the largest healthcare organization in the region, with 12 hospitals, more than 24,000 employees, 4,000 physicians and 100 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties.
A not-for-profit organization supported by philanthropy and committed to its faith-based charitable mission of medical excellence, Baptist Health has been recognized by Fortune as one of the 100 Best Companies to Work For in America and by Ethisphere as one of the World's Most Ethical Companies.
Everything we do at Baptist Health, we do to the best of our ability. That includes supporting our team with extensive training programs, millions of dollars in tuition assistance, comprehensive benefits and more. Working within our award-winning culture means getting the respect and support you need to do your best work ever. Find out why we're all in for helping you be your best.Description:
Functions as a senior expert consultant for Case Management to ensure high quality patient care, appropriate ALOS, efficient resource utilization, application of regulatory and national guidelines to ensure medical necessity is appropriate for expected reimbursement.
Consults with attending physician, physician advisor, and case managers to formulate secondary appeals and written formal appeals using appropriate medical management tools for medical necessity determination (
MCG/Interqual/ CMS guidelines).
Serves as the expert internal consultant for multiple departments (HSS, PFS, Compliance, Surgery, Transfer Center, etc.) related to regulatory and billing requirements (LCD/NCD/EBC criteria).
Serves as liaison between hospital and eQ health, CMS and when appropriate their Contractors such as the MAC, QIO, ALJ, Medicare Council, and the RAC and prepares appeals for all of the above.
Reviews all surgery cases across BHSF pre and post procedure to ensure appropriate CPT, LOC, Relevant testing, authorization and medical necessity is present in the EMR prior to billing.
Makes billing recommendation for all medical and surgical accounts as applicable by payorEstimated salary range for this position is $ $ / year depending on experience
Qualifications:
Degrees:
Bachelors
Licenses & Certifications:
MCG
ANCC Nursing Case Management
AAMCN Utilization Review Professionals
ABMCM Certified Managed Care Nurse
AACN Acute/Critical Care Nursing (Adult, Pediatric & Neonatal)
CCMC Case Manager
Registered Nurse
ACMA ACM Certification
Additional Qualifications:
RNs hired prior to 2/2012 with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN, however,they are required to complete the BSN within 5 years of hire.
RN license & one of the listed certifications is required.3 years of hospital clinical experience preferred & 2 years of hospital or payor Utilization management review experience required.
Excellent written, interpersonal communication & negotiation skills.Strong critical thinking skills & the ability to perform clinical chart review abstract information efficiently. Strong analytical,data management & computer skills/Word /Excel.
Strong organizational & time management skills,as evidenced by capacity to prioritize multiple tasks & role components.
Current working knowledge of payor & managed care reimbursement preferred.
Ability to work independently & exercise sound judgment in interactions with the health care team & patients/families.
Knowledgeable in local, state, & federal legislation & regulations.
Ability to tolerate high volume production st&ards.
MCG Certification or eligible to pursue within 90 days of hire. Case management,utilization review/surgery pre-anesthesia experience preferred.
Familiar with CPT, ICD-9 &-10 & DRG coding preferred.
Strong ability to research evidence-based practices.
Minimum Required Experience:
3
EOE
