Medical Reviewer, Appeals and Hearings Specialist
3 weeks ago
We are seeking a dedicated and skilled Nurse Reviewer, Appeals and Hearings to join our team at Gainwell Technologies. In this role, you will be responsible for reviewing provider appeals and redeterminations using approved clinical and coding guidelines, documenting determinations clearly and concisely, and preparing case files and case summaries for hearings.
Key Responsibilities:- Reviews provider appeals and redeterminations using approved clinical and coding guidelines.
- Documents appeal determinations clearly and concisely.
- Prepares case files and case summaries for hearings.
- Participates in virtual and on-site hearings.
- Trains new reviewers in daily monitoring, mentoring, feedback, and education.
- Maintains current knowledge of clinical criteria guidelines and/or coding guidelines.
- Active, unrestricted RN licensure from the United States and in the state of primary home residency.
- Compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).
- Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA) preferred.
- 5+ years clinical experience or 5+ years medical record coding experience preferred.
- Working knowledge of the appeals and hearings process.
- Excellent written communication skills, including ability to write clear, concise, accurate, and fact-based rationales in support of appeal determinations.
- Full-time permanent regular salaried (W-2) employee position.
- Upward career advancement is possible and encouraged.
- Health (medical, dental, vision) and paid time off benefits start on day 1 of employment.
- Company match 401K and other benefits available within months of starting.
- Computer and other company-provided items.
This is a remote position with a requirement for broadband internet connection with a minimum speed of 24MBS download and 8MBS upload.
-
Hearing Solutions Expert
5 days ago
Lexington, Kentucky, United States Lexington Clinic Full timeLexington Clinic is committed to providing exceptional patient care and is seeking a skilled Hearing Solutions Expert to join our team. The ideal candidate will have a strong understanding of audiology principles and the ability to communicate complex information effectively.About the Job:This role involves evaluating hearing loss in individuals and...
-
Medical Claims Specialist
1 month ago
Lexington, Kentucky, United States Medical Services of America Full timeAbout Medical Services of AmericaAt Medical Services of America, we are committed to delivering exceptional home healthcare solutions that improve the lives of our patients. Our comprehensive services include home healthcare, hospice care, and medical equipment supplies.Job Summary:We seek a highly skilled Reimbursement Specialist to join our Corporate...
-
Compensation and Benefits Specialist
3 weeks ago
Lexington, Kentucky, United States Medical Services of America Full timeAbout the JobWe are seeking a highly skilled Reimbursement Specialist to join our team at Medical Services of America in Lexington, SC.The successful candidate will be responsible for submitting and re-billing claims with various pay sources and locations as assigned.This includes tracking reasons for unpaid claims and re-billing as necessary, filing...
-
Lexington, Kentucky, United States Medical Services of America Full timeJob DescriptionWe are seeking a highly skilled Compensation Specialist for Healthcare Reimbursement to join our team in Lexington, SC.This role is responsible for managing and submitting claims for various pay sources and locations.Coordinates the submission of claims to ensure timely payment.Tracks and resolves reasons for unpaid claims through re-billing...
-
Diagnostic Medical Imaging Specialist
3 weeks ago
Lexington, Kentucky, United States Magnet Medical Full timeMagnet Medical is a healthcare provider seeking a skilled Diagnostic Medical Imaging Specialist for a travel assignment in Kentucky.Job Overview:Specialty: Ultrasound TechnologistDiscipline: Allied Health ProfessionalThe selected candidate will perform medical imaging procedures using ultrasound equipment to create images or videos of a patient's internal...
-
Department Support Specialist
1 day ago
Lexington, Kentucky, United States Town of Lexington Massachusetts Full timeOverviewThe Town of Lexington Massachusetts is seeking an organized and detail-oriented Department Support Specialist to provide administrative support to the Land Use, Housing and Development Department. As a key member of our team, you will be responsible for coordinating various tasks, meeting deadlines, and maintaining accurate records.Key...
-
Medical Imaging Specialist
2 days ago
Lexington, Kentucky, United States OneStaff Medical Full timeOneStaff Medical is seeking a highly skilled Medical Imaging Specialist for a travel assignment in a dynamic healthcare setting. This role requires an individual with exceptional technical expertise and excellent communication skills to work closely with medical professionals during complex cardiovascular procedures.Key Responsibilities:Assist cardiologists...
-
Retail Sales Specialist
2 weeks ago
Lexington, Kentucky, United States Torrid Full timeTorrid is seeking a Retail Sales Specialist to provide an exceptional customer experience and drive sales. As a key member of our sales team, you will be responsible for ensuring all visual standards are met, performing register functions, and utilizing your product knowledge to drive add-on sales.Key Responsibilities:Provide a positive shopping experience...
-
Diagnostic Medical Imaging Specialist
4 days ago
Lexington, Kentucky, United States Magnet Medical Full timeJob Overview Magnet Medical is a leading provider of medical imaging services, seeking an experienced Diagnostic Medical Imaging Specialist to join our team. This exciting opportunity will allow the successful candidate to utilize their skills and expertise in performing medical imaging procedures using ultrasound equipment. Key Responsibilities ...
-
Medical Records Specialist
2 days ago
Lexington, Kentucky, United States CommonSpirit Health Full timeAbout the Role:The Billing Specialist II position at CommonSpirit Health is a vital part of our team, responsible for ensuring accurate and timely data entry into our Electronic Health Record (EHR) system.Key Responsibilities:Import transcribed documents into Mosaiq for all oncologists and mid-level practitioners in the Lexington market.Make corrections to...
-
Travel Medical Imaging Specialist
3 days ago
Lexington, Kentucky, United States OneStaff Medical Full timeJob OverviewWe are seeking a highly skilled Travel Medical Imaging Specialist to join our team at OneStaff Medical. As a Diagnostic Imaging Professional, you will be responsible for performing high-quality imaging procedures using advanced medical equipment. This is a unique opportunity to work in a fast-paced environment and contribute to the delivery of...
-
Mobile Diagnostic Imaging Specialist
3 weeks ago
Lexington, Kentucky, United States Magnet Medical Full timeJob Title: Mobile Diagnostic Imaging SpecialistWe are seeking a highly skilled Mobile Diagnostic Imaging Specialist to join our team at Magnet Medical. This is a travel opportunity that offers the chance to work in various locations while utilizing your expertise in diagnostic imaging.Job Description:Perform diagnostic imaging procedures using ultrasound...
-
Medical Social Work Specialist
3 weeks ago
Lexington, Kentucky, United States Saratoga Medical Center Full timeWe are seeking a skilled Medical Social Worker to join our team at Saratoga Medical Center in Bedford, MA. As a Medical Social Work Specialist, you will play a vital role in providing care coordination and discharge planning services to our patients.Estimated salary: $45,000 - $55,000 per year, depending on experience.The ideal candidate will have a Master's...
-
Medical Coding Specialist
3 weeks ago
Lexington, Kentucky, United States PSG Global Solutions Careers Full timeA HEDIS Coder/Abstractor is sought by PSG Global Solutions Careers to review medical records, document clinical data, and extract relevant details for HEDIS reporting. The ideal candidate will have 2+ years of experience in HEDIS and/or quality improvement, as well as medical coding. Key Responsibilities:Extract Clinical Data: Identify and extract clinical...
-
Medical Imaging Specialist for Travel Assignment
3 weeks ago
Lexington, Kentucky, United States Summit Medical Staffing Allied Full timeAbout the RoleSummit Medical Staffing Allied is seeking a highly skilled Medical Imaging Specialist to fill a travel assignment in Lexington, Kentucky.
-
Maintenance Specialist
3 weeks ago
Lexington, Kentucky, United States RealSource Properties Full timeJob Title: Maintenance SpecialistAt RealSource Properties, we are seeking a highly skilled and motivated Maintenance Specialist to join our team. This is a full-time position responsible for ensuring the physical aspects of our properties meet our established standards for safety, appearance, and operational efficiency.Key Responsibilities:Troubleshoot...
-
Medication Specialist
3 weeks ago
Lexington, Kentucky, United States Dungarvin Full timeJob Title:Medication SpecialistAbout the RoleThe Medication Specialist will be responsible for overseeing the medication administration process for participants. This involves working closely with Dungarvin's designated Pharmacy to ensure accurate and up-to-date medication records, and monitoring medication QA in the homes and reporting documentation and...
-
Medical Professional
3 days ago
Lexington, Kentucky, United States The University of Kentucky Full timeThe University of Kentucky values the contributions of our dedicated medical professionals. As a Clinical Care Specialist, you will be responsible for delivering high-quality patient care in our ICU environment. Your duties will include assessing and documenting patient needs, planning and implementing comprehensive care plans, teaching patients and families...
-
Medical Travel Specialist
4 days ago
Lexington, Kentucky, United States OneStaff Medical Full timeJob OverviewOneStaff Medical is seeking a skilled medical professional to join our team as a travel specialist in telemetry nursing.Key Responsibilities:Monitor patients' vital signs and provide high-quality care in a hospital settingCollaborate with healthcare teams to ensure seamless patient careCommunicate effectively with colleagues and supervisors to...
-
Non-Medical Support Specialist
3 weeks ago
Lexington, Kentucky, United States BLUE GRASS CHOICE NON-MEDICAL HOME Full timeAbout the RoleAs a Non-Medical Support Specialist with Blue Grass Choice Non-Medical Home, you will be responsible for providing emotional support and companionship to clients in their homes. This may include assisting with daily living activities, such as meal preparation, light housekeeping, and transportation.You will work closely with clients and their...