123 payment integrity rn jobs found

PAYMENT INTEGRITY RN (I) (Clinician) (HEALTHCARE) Work from home (telecommute) within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For Every day, Cambia’s dedicated Clinical Audit team is living our mission to make health care easier and lives better. As a member of the Clinical Audit team, the Payment Integrity RN (I) conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. Applies resources, including but not limited to, internal medical and reimbursement policies and correct coding guidelines based on national standards to support claim review and determination. – all in service of making our members’ health journeys easier. If you're a motivated and detail-oriented clinician looking to make a difference in payment...

PAYMENT INTEGRITY RN (I) (Clinician) (HEALTHCARE) Work from home (telecommute) within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For Every day, Cambia’s dedicated Clinical Audit team is living our mission to make health care easier and lives better. As a member of the Clinical Audit team, the Payment Integrity RN (I) conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. Applies resources, including but not limited to, internal medical and reimbursement policies and correct coding guidelines based on national standards to support claim review and determination. – all in service of making our members’ health journeys easier. If you're a motivated and detail-oriented clinician looking to make a difference in payment...

PAYMENT INTEGRITY RN (I) (Clinician) (HEALTHCARE) Work from home (telecommute) within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For Every day, Cambia’s dedicated Clinical Audit team is living our mission to make health care easier and lives better. As a member of the Clinical Audit team, the Payment Integrity RN (I) conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. Applies resources, including but not limited to, internal medical and reimbursement policies and correct coding guidelines based on national standards to support claim review and determination. – all in service of making our members’ health journeys easier. If you're a motivated and detail-oriented clinician looking to make a difference in payment...

PAYMENT INTEGRITY RN (I) (Clinician) (HEALTHCARE) Work from home (telecommute) within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For Every day, Cambia’s dedicated Clinical Audit team is living our mission to make health care easier and lives better. As a member of the Clinical Audit team, the Payment Integrity RN (I) conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. Applies resources, including but not limited to, internal medical and reimbursement policies and correct coding guidelines based on national standards to support claim review and determination. – all in service of making our members’ health journeys easier. If you're a motivated and detail-oriented clinician looking to make a difference in payment...

PAYMENT INTEGRITY RN (I) (Clinician) (HEALTHCARE) Work from home (telecommute) within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For Every day, Cambia’s dedicated Clinical Audit team is living our mission to make health care easier and lives better. As a member of the Clinical Audit team, the Payment Integrity RN (I) conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. Applies resources, including but not limited to, internal medical and reimbursement policies and correct coding guidelines based on national standards to support claim review and determination. – all in service of making our members’ health journeys easier. If you're a motivated and detail-oriented clinician looking to make a difference in payment...

PAYMENT INTEGRITY RN (I) (Clinician) (HEALTHCARE) Work from home (telecommute) within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For Every day, Cambia’s dedicated Clinical Audit team is living our mission to make health care easier and lives better. As a member of the Clinical Audit team, the Payment Integrity RN (I) conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. Applies resources, including but not limited to, internal medical and reimbursement policies and correct coding guidelines based on national standards to support claim review and determination. – all in service of making our members’ health journeys easier. If you're a motivated and detail-oriented clinician looking to make a difference in payment...

PAYMENT INTEGRITY RN (I) (Clinician) (HEALTHCARE) Work from home (telecommute) within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For Every day, Cambia’s dedicated Clinical Audit team is living our mission to make health care easier and lives better. As a member of the Clinical Audit team, the Payment Integrity RN (I) conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. Applies resources, including but not limited to, internal medical and reimbursement policies and correct coding guidelines based on national standards to support claim review and determination. – all in service of making our members’ health journeys easier. If you're a motivated and detail-oriented clinician looking to make a difference in payment...

Full job description PAYMENT INTEGRITY RN (I) (Clinician) (HEALTHCARE) Work from home (telecommute) within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia’s dedicated Clinical Audit team is living our mission to make health care easier and lives better. As a member of the Clinical Audit team, the Payment Integrity RN (I) conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. Applies resources, including but not limited to, internal medical and reimbursement policies and correct coding guidelines based on national standards to support claim review and determination. – all in service of making our members’ health journeys easier. If you're a motivated and...

Purdue Pharma L.P. and its subsidiaries develop, manufacture and market medications to meet the evolving needs of healthcare professionals, patients, and caregivers. We were founded by physicians, and we are currently led by a physician. Beyond our efforts to provide quality medications, Purdue is committed to supporting national, regional and local collaborations to drive innovations in patient care. Privately held, Purdue is pursuing a pipeline of new medications through internal research & development and strategic industry partnerships. For close to two decades Purdue has engaged in many initiatives to stem prescription opioid abuse. We are committed to bringing lifesaving relief to communities and individuals suffering from substance use disorder and overdose. We are currently developing or supporting the development of two essential life-saving opioid overdose reversal medications and have the capability to manufacture others for medication assisted treatment....

Full job description Purdue Pharma L.P. and its subsidiaries develop, manufacture and market medications to meet the evolving needs of healthcare professionals, patients, and caregivers. We were founded by physicians, and we are currently led by a physician. Beyond our efforts to provide quality medications, Purdue is committed to supporting national, regional and local collaborations to drive innovations in patient care. Privately held, Purdue is pursuing a pipeline of new medications through internal research & development and strategic industry partnerships. For close to two decades Purdue has engaged in many initiatives to stem prescription opioid abuse. We are committed to bringing lifesaving relief to communities and individuals suffering from substance use disorder and overdose. We are currently developing or supporting the development of two essential life-saving opioid overdose reversal medications and have the capability to manufacture others for medication...

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Position Overview The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments. Conduct review of facility and outpatient bills as it compares with medical records and coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest possible savings for clients. Key Responsibilities RN or LPN required. Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs. Demonstrates expert understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers. 3-5 years of auditing, claims, review and/or billing experience with a health care organization or provider preferred. 2+ years of auditing or performing claims review in specialty pharmacy...

Love + medicine is who we are, it's what we do, it's why people want to work here. If you’re looking for a job to love, apply today. Scheduled Weekly Hours: 40 Job Description: Job Description Position Title: Director, Outpatient Operations Last Reviewed: 12/13/2021 Salary Class: Exempt Department: Westfield and Friendship Rural Health Clinics, Medical Imaging, Specialty Clinic, Patient Care Associates, Employee Health, and Surgery. Position Code: 4775 Reports To: Administrator POSITION SUMMARY The Director of Outpatient Operations functions as a member of the senior management team and provides strategic leadership for organizational activities, integrating the Mission and Values of Gundersen Moundview Hospital and Clinics. Manages the operational and administrative functions and activities of the ambulatory care clinics, Medical Imaging, Patient Care Associates, both Retail and Hospital Pharmacies, Surgery, and...

Position Overview The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments. Conduct review of facility and outpatient bills as it compares with medical records and coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest possible savings for clients. Key Responsibilities RN or LPN required. Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs. Demonstrates expert understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers. 3-5 years of auditing, claims, review and/or billing experience with a health care organization or provider preferred. 2+ years of auditing or performing claims review in specialty pharmacy...

Position Overview The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments. Conduct review of facility and outpatient bills as it compares with medical records and coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest possible savings for clients. Key Responsibilities RN or LPN required. Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs. Demonstrates expert understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers. 3-5 years of auditing, claims, review and/or billing experience with a health care organization or provider preferred. 2+ years of auditing or performing claims review in specialty pharmacy...

Position Overview The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments. Conduct review of facility and outpatient bills as it compares with medical records and coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest possible savings for clients. Key Responsibilities RN or LPN required. Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs. Demonstrates expert understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers. 3-5 years of auditing, claims, review and/or billing experience with a health care organization or provider preferred. 2+ years of auditing or performing claims review in specialty pharmacy...

At Boston Medical Center (BMC), our nurses are changing the face of healthcare. At every level and on every unit, BMC nurses are advancing professional practice and delivering evidence-based care to our patients, families, and community. Join our Magnet® recognized organization as a registered nurse (RN) and help us continue to carry out our mission of delivering exceptional and equitable care to all As both the largest trauma hospital and largest safety net hospital in New England, you get a chance to be a part of exciting leading edge clinical care, in a truly mission driven organization. As one of the top places to work in health care, we know that providing exceptional care for patients begins with caring for our staff. That’s why you’ll find a supportive work environment at BMC, with rich opportunities throughout your career for training, development, and growth and where you’ll have the tools you need to take charge of your own practice environment. There’s never been a...

Full job description Req#: R32926 Category(s): Nursing, Inpatient Direct Care Nurses Full Time / Part Time: Part-Time Shift: Third ***SIGN-ON BONUS ELIGIBLE*** Baystate Health, a nationally recognized leader in healthcare quality and safety, and home to Baystate Franklin Medical Center is looking for a Registered Nurse (RN) to join our Obstetrics team in Greenfield, MA ! At Baystate Health, RN means more. It stands for our deep respect for nursing professional practice that is essential to our mission. It also stands for Baystate’s many opportunities for growth and learning in the region’s only academic medical center and within our community hospitals, and it stands for our commitment to taking care of all those in the community who need us. Baystate Franklin Medical Center is an 89-bed community hospital in Greenfield, MA. Rooted in a rich tradition of service and accountability to the people of Franklin County, North Quabbin,...

At Boston Medical Center (BMC), our nurses are changing the face of healthcare. At every level and on every unit, BMC nurses are advancing professional practice and delivering evidence-based care to our patients, families, and community. Join our Magnet® recognized organization as a registered nurse (RN) and help us continue to carry out our mission of delivering exceptional and equitable care to all As both the largest trauma hospital and largest safety net hospital in New England, you get a chance to be a part of exciting leading edge clinical care, in a truly mission driven organization. As one of the top places to work in health care, we know that providing exceptional care for patients begins with caring for our staff. That’s why you’ll find a supportive work environment at BMC, with rich opportunities throughout your career for training, development, and growth and where you’ll have the tools you need to take charge of your own practice environment. There’s never been a...

Primary City/State: Fallon, Nevada Department Name: Work Shift: Varied Job Category: Clinical Care Experience innovative technology and exceptional opportunities . If you’re looking to leverage your abilities to make a real difference – and real change in the health care industry – you belong at Banner Health. Apply today. Banner Health was named to Fortune’s America’s Most Innovative Companies list for the second year in a row for 2024 and named Most Trustworthy Companies in America by Newsweek. We’re proud to be recognized for our commitment to the latest health care advancements and excellent patient care. Fallon is surrounded by wide-open spaces, internationally known wetlands, historic Pony Express trails, state parks, hiking opportunities, and places to go off-road. Play outdoors for a while then come back into town for some indoor, Nevada-style fun, great dinner, and entertainment. Since 1996, Banner Churchill Community Hospital has...

Overview: UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system based in Orange County. UCI Health is comprised of its main campus, UCI Medical Center, a 459-bed, acute care hospital in in Orange, Calif., four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties and ambulatory care centers across the region. Listed among America’s Best Hospitals by U.S. News & World Report for 23 consecutive years, UCI Medical Center provides tertiary and quaternary care and is home to Orange County’s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center, gold level 1 geriatric emergency department and regional burn center. UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast...

Company Allegheny Health Network Job Description Date Posted: 20240906 Location: Allegheny General Hospital Department: Case Management, Inpatient Status: Full Time Shift: 80 hours every two weeks Daylight M-F, 40 hours per week, rotating weekends and holidays Union: Yes Case Management The Case Management Department at Allegheny General Hospital assists patients and their support systems in managing medical conditions effectively. Our team of talented Case Managers aims to individualize health care to meet each patient's specific needs with a patient-centric and outcome-driven focus. Allegheny General Hospital AGH is a Level I Shock Trauma Center 5 state of the art ICU’s State of the art Cancer Center 550+ Beds Allegheny Health Network At AHN, employees trust working together and place patients at the center of all they do. This 9 Hospital system, a part of Highmark Health, is transforming the future of healthcare by providing highly...

Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann & Robert H. Lurie Children’s Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report. Day (United States of America) Location Lurie Children's Pediatrics - Uptown Job Description The Manager of Patient Care Operations collaborates with the Director/Administrator within designated areas of responsibility to manage patient care operations and ensure the delivery of excellent patient care. They work with the leadership team to create a work environment that engages staff in the attainment of department and organizational goals and vision. They understand and integrate into the delivery of...

Company : Highmark Health Job Description : JOB SUMMARY This job is directly responsible for outcomes of providers contracted in the Organization's gain/risk share arrangements and is a highly skilled expert in practice transformation to achieve the specific targets set in the individual gain/risk share contracts and is strategically focused on those data gaps that will result in the greatest ROI for the Organization. Further, in a matrix management environment, will be responsible for collaborative work with the other members of the value-based reimbursement team, provider relations, senior markets, analytics, actuary and key internal/external stake holders to provide the most appropriate support for providers with gain/risk share contracts. ESSENTIAL RESPONSIBILITIES Directly responsible for supporting providers contracted in the Organization's gain/risk share programs, with a goal of maximizing quality and ROI for the Organization. This includes...