6 claims nurse jobs at 5 companies in Springfield, VA
2mo
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Referral Management (Non-Nurse) Reviewer
Bethesda, Maryland, United States
$24/hr OnsiteFull Time
2+ YOEAssociate's degree, 2+ years in utilization/referral/authorization/claims processing, U.S. citizenship with ability to obtain Public Trust clearance, knowledge of InterQual/Milliman/SRGs, familiarity with MHS/TRICARE/HIPAA, and Microsoft Office proficiency.
Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Microsoft Access, Microsoft Outlook, MHS-GENESIS, Genesis Work Lists, External Provider Referral Online (EPRO)
3w
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Vendor Auditor (672269)
Hanover, Maryland, United States
$29-$48/hr RemoteFull Time
3+ YOECollege degree preferred (nursing, accounting, business, or healthcare) or 3 years advanced claims auditing; strong knowledge of claims adjudication, Medicare/Medicaid, and analytical skills.
2w
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Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)
Denver or Atlanta or Costa Mesa or Hanover or Walnut Creek or Chicago or Las Vegas or Mendota Heights or New York City or Seattle
$87k-$156k/yr RemoteFull Time
10+ YOEActive unrestricted RN license; 10 years in claims auditing, quality assurance, or clinical documentation improvement; 5 years with ICD-9/10-CM and DRG systems. Preferred coding or documentation credentials.
ICD-9, ICD-10-CM, MS-DRG, AP-DRG, APR-DRG
1mo
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Risk Manager
Manassas or Haymarket or Culpeper
$43-$73/hr OnsiteFull Time
5+ YOEBachelor's degree (BSN or comparable), RN licensure, 5+ years clinical experience, 3+ years risk/quality/leadership preferred, incident investigation, claims reporting, policy drafting, and strong Microsoft and Epic skills.
Epic, Microsoft Outlook, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
2w
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Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)
Mason or Atlanta or Costa Mesa or Hanover or Indianapolis or Las Vegas or Denver or New York or Chicago or Norfolk
$87k-$156k/yr RemoteFull Time
10+ YOEActive unrestricted RN license, 10+ years claims auditing/quality or CDI experience, 5+ years DRG coding experience (ICD-9/10CM, MS-DRG/AP-DRG/APR-DRG), audit expertise and clinical documentation knowledge.
ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG
1mo
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Director Risk Management
Washington, District of Columbia, United States
$125k-$220k/yr OnsiteFull Time
5+ YOEBachelor's in risk management/nursing or related required; 5+ years healthcare risk management experience; RN licensure and CPHRM preferred; experience with claims management and event investigation.
CMAPS