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Appeals Nurse at Blue Cross Blue Shield of Massachusetts - ApplyBlast

Appeals Nurse

Blue Cross Blue Shield of Massachusetts

5 months ago

3.1 on Glassdoor

Hingham

Onsite

Full Time

Senior

0 applicants

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About this role

A Clinical Appeals Nurse Reviewer facilitates, coordinates, and responds to provider appeals for denied services using clinical, regulatory, business, and coding knowledge.

Responsibilities

Review appeals using clinical judgement and coding guidelines
Collaborate with Physician Review Unit for medical necessity determinations
Analyze claims for appropriate billing and payment
Validate billing and services using HCPCS, CPT, ICD-10
Resolve provider claims appeals with multiple departments

Skills

Qualifications

Registered NurseCredentialed Coder (CPC, CCS)BSN PreferredMassachusetts Licensure

About Blue Cross Blue Shield of Massachusetts

bluecrossma.org

Headquarters

Boston, Massachusetts, United States

Company Size

1001-5000 employees

Founded

1937

View Profile

Blue Cross Blue Shield of Massachusetts brings health insurance plans, medical claims, insurance coverage, benefits and telehealth via MyBlue Web & App