Top 338 Denials Jobs in Virginia

Nurse Reviewer (Medicare)
Commence —Virginia
- $82,000 - $95,000 a year
- Online Application
- Remote
- Nursing
- RN License
- HIPAA
4d
Reimbursement Specialist - Days - Remote
VCU Health System —Richmond, VA
- $19.87 - $30.79 an hour
- Weekends as needed
- Remote
- Word processing
- Research
- Mid-level
Epic Denials Management Operator
Deloitte —McLean, VA
- $70,000 - $90,000 a year
- Full-time
- Microsoft Excel
- Mid-level
- Bachelor's degree
AR Specialist I
Sentara Hospitals —Virginia Beach, VA
- Full-time
- Hybrid work
- Office
- Administrative experience
- High school diploma or GED
- 403(b) matching
- Paid parental leave
Quick Apply
Fraud and Abuse Investigator / CPC - Remote
Sentara Workforce Solutions, LLC —Virginia Beach, VA
- $25.60 - $42.67 an hour
- Overtime
- Remote
- Mid-level
- Bachelor's degree
- 2 years
- 403(b) matching
- Paid parental leave
Quick Apply
4d
Medical Facilities Inspector
Virginia Department of Health —Falls Church, VA
- $88,000.00 - $101,119.50 a year
- Full-time
- RN License
- Writing skills
- Mid-level
- Paid holidays
- Health insurance
7d
Manager, Enterprise Professional Coding Denials
University of Virginia —Charlottesville, VA
- $110,000 - $138,432 a year
- Full-time
- Management
- Bachelor's degree
- Travel
- Disability insurance
- Health insurance
PDN Home Health Authorization Specialist
COMFORT HOME HEALTH LLC —Falls Church, VA
- $25 - $30 an hour
- Full-time
- Hybrid work
- Spanish
- HIPAA
- English
- Health insurance
- 401(k)
Quick Apply
Revenue Cycle Specialist
Unified Women's Healthcare —Virginia
- Full-time
- Remote
- Mid-level
- High school diploma or GED
- No travel
- Commuter assistance
- Paid parental leave
Accounts Receivable Specialist II
Sentara Hospitals —Norfolk, VA
- Full-time
- Hybrid work
- Mid-level
- 3 years
- High school diploma or GED
- 403(b) matching
- Paid parental leave
Quick Apply
Revenue Integrity Specialist PB
Inova Health System —Virginia
- Full-time
- Remote
- 5 years
- Mid-level
- Children
- Wellness program
- Paid parental leave
12d
Authorization & Verification Specialist - Acute Team
ContinuumRx —Chantilly, VA
- Full-time
- Microsoft Word
- Microsoft Excel
- HIPAA
Quick Apply
Physician Insurance Analyst 4
Inova Health System —Falls Church, VA
- Full-time
- Mid-level
- Office
- Administrative experience
- Wellness program
- Health insurance
11d
ESIS Claims Representative, WC
Chubb —Glen Allen, VA
- $62,700 - $81,300 a year
- Full-time
- Microsoft Word
- Microsoft Excel
- Mid-level
Chemotherapy Authorization Specialist
Virginia Oncology Associates —Newport News, VA
- $47,964.80 - $128,939.20 a year
- Full-time
- Research
- Mid-level
- 3 years
- 401(k)
12d
Epic Denials Management Coordinator
Deloitte —Richmond, VA
- $50,000 - $60,000 a year
- Full-time
- Microsoft Excel
- Mid-level
- Bachelor's degree
Director of Clinical Compliance
Tandem Behavioral Health —Roanoke, VA
- $90,000 - $105,000 a year
- LMFT
- Licensed Clinical Social Worker
- LPC
- Fuel card
- Paid time off
Quick Apply
13d
Invasive Coding Analyst - Ortho
Carilion Clinic —Roanoke, VA
- $23.23 - $32.52 an hour
- Online Application
- Research
- Mid-level
- Office
- Health insurance
- Dental insurance
Leasing Consultant (CM7308ar)
Dreyfuss Management —Falls Church, VA
- From $21.50 an hour
- Weekends as needed
- Background check
- Spanish
- Microsoft Excel
- Health insurance
- Dental insurance
Quick Apply
14d
Security Clearance Adjudication Senior Consultant, Forensics and Investigations
Deloitte —Rosslyn, VA
- $97,700 - $162,800 a year
- Full-time
- Office
- 3 years
- Bachelor's degree
3d

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denials jobs near virginia

Nurse Reviewer (Medicare)

Commence
Virginia

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Job Details

Full-time
$82,000 - $95,000 a year
4 days ago

Qualifications

Nursing
Medicare
RN License
CMS
CMS regulatory compliance
Pre-authorization review for utilization management
Medicare regulations
Clinical documentation standards
Medical terminology
Nursing

Full Job Description

Description:

At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care.

With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.?

Requirements:

The Nurse Reviewer performs complex medical record reviews of Medicare Part A/B and DMEPOS claims that require clinical judgment in order to assess the potential for overpayment or fraud. Using established criteria/ and clinical guidelines, the Nurse Reviewer is responsible for making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical standards of care.

Required Qualifications

Graduation from an accredited school of nursing with current, unrestricted licensure as a Registered Nurse (RN); active compact multistate RN license acceptable
License recognized in the jurisdiction(s) relevant to the assigned work; for federal contract work, license must be issued by a body within the United States
2–4 years of clinical experience, with demonstrated ability to apply clinical judgment to medical necessity, coverage, and appropriateness-of-care determinations under NCDs, LCDs, and CMS coverage policy
Detail-oriented, with strong working knowledge of medical terminology and clinical documentation standards
Associate's degree (or accredited nursing diploma) in a healthcare-related field with a professional clinical background
Experience in medical/claims review, including pre- and post-payment claims reviews and/or utilization review

Preferred Qualifications

MAC or RAC appeals review experience
CPC (or similar) coding certification
Prior work as a Medicare medical review nurse for a MAC, RAC, QIO, or SMRC-type contractor
Insurance industry experience

Key Responsibilities

Perform complex medical record reviews requiring clinical judgment on Medicare Part A/B and DMEPOS claims
Determine coverage, medical necessity, and appropriateness of services against NCDs, LCDs, and CMS coverage/payment policy
Document clear, defensible rationale for payment or denial recommendations
Identify evidence of medical record alteration or documentation patterns suggestive of fraud, waste, or abuse
Participate in provider education sessions, explaining review rationale directly to providers/suppliers
Support claim(s) re-review when additional documentation is submitted
Maintain a 95%+ individual accuracy score and participate in inter-rater reliability/peer-review QA activities
Complete required annual trainings and maintain HIPAA/PHI compliance

Work Environment/Physical Demands

The work environment and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This is a remote position. While performing the duties of this job, the employee regularly works in a climate-controlled environment. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch.

Commence is an equal employment opportunity for employer. All personnel processes are merit-based and applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law.

Commence.AI is committed to providing equal employment opportunities to all applicants, including individuals with disabilities. If you require reasonable accommodation to participate in the application process due to a disability, please contact Human Resources at (757) 306-4920 or [email protected]. Please note that unless you are requesting an accommodation, all applications must be submitted through our online application system.

Apply Now

Refine Your Search

denials jobs in virginia

Nurse Reviewer (Medicare)

Reimbursement Specialist - Days - Remote

Epic Denials Management Operator

AR Specialist I

Fraud and Abuse Investigator / CPC - Remote

Medical Facilities Inspector

Manager, Enterprise Professional Coding Denials

PDN Home Health Authorization Specialist

Revenue Cycle Specialist

Accounts Receivable Specialist II

Revenue Integrity Specialist PB

Authorization & Verification Specialist - Acute Team

Physician Insurance Analyst 4

ESIS Claims Representative, WC

Chemotherapy Authorization Specialist

Epic Denials Management Coordinator

Director of Clinical Compliance

Invasive Coding Analyst - Ortho

Leasing Consultant (CM7308ar)

Security Clearance Adjudication Senior Consultant, Forensics and Investigations

I want to receive the latest job alert for denials in virginia

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