Medical Claims Review Nurse Salary in Nashville, Tennessee

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Average Salary for Medical Claims Review Nurse in Nashville, Tennessee

The average salary of a(n) Medical Claims Review Nurse in Nashville, Tennessee is $69,355.

The average hourly rate of a(n) Medical Claims Review Nurse in Nashville, Tennessee is $33.34.

The average bonus of a(n) Medical Claims Review Nurse in Nashville, Tennessee is $1,130.00.

Job Description:

Resolves, audits, and processes claims for clinically related issues to ensure accuracy of claims payment, supporting the Claims Administration Department. Maintains contact with community hospitals and providers, reviewing, processing, and auditing claims for payment and appropriateness of charges and pursues adjustments as warranted. Typically requires licensure as a Registered Nurse and at least one year of experience in utilization review or a managed care setting. Screens, audits, and processes claims of specific criteria for appropriate payment. Establishes effective ongoing relationships with community hospitals and providers. Participates in educational, provider relations, and contracting meetings with providers to address medical claims payment issues. Visits the providers as necessary to compare billed charges to the medical record. Provides support to the Accounting Department in determining financial liability for out-of-plan medical services. Performs special projects, reconciliations, research, and analysis relating to the utilization and cost of medical services. Works closely with various departments to coordinate the flow of information involving payment of medical bills and analyses of financial liability. Ensures compliance with contractual obligations on claims payments. Documents findings and writes follow-up reports. Recommends and implements innovative strategies to retain members, contain medical costs, and improve efficiency. Less

Resolves, audits, and processes claims for clinically related issues to ensure accuracy of claims payment, supporting the Claims Administration Department. Maintains contact with community hospitals and providers, reviewing, processing, and auditing claims for payment and appropriateness of charges and pursues... More

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Results for Medical Claims Review Nurse in Nashville, Tennessee

SSC- Appeal Nurse - Franklin, TN

Shared Services Center - Franklin

SSC- Appeal Nurse. Review all assigned inpatient denials; Utilization review and/or case management experience preferred....

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Insurance Specialist (Medical Billing Experience) - Nashville - FT - Nashville, TN

850 - The Little Clinic - Corporate

Review and respond to payer correspondence. Submit appeals as needed for denied claims. Analyze, audit and resolve claims outstanding, denied, or incorrectly...

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Utilization Management Representative l-III - Nashville, TN - 8/1 - 110676 - Nashville, TN

Anthem, Inc.

Refers cases requiring clinical review to a Nurse reviewer. Medical terminology training and experience in medical or insurance field preferred....

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Care Senior Associate - Nashville, TN

Cigna

Completes review of non authorized medical claims. Auto approve, refer to Precert Nurse or Medical Director)....

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LPN Medical Reviewer I - Nashville, TN

CGS Administrators

Provides support and review of medical claims and utilization practices. Utilization review experience. Performs medical reviews using established criteria sets...

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