Medical Claims Review Nurse Salary in Arizona - State Average

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Average Salary for Medical Claims Review Nurse in Arizona - State Average

The average salary of a(n) Medical Claims Review Nurse in Arizona - State Average is $71,595.

The average hourly rate of a(n) Medical Claims Review Nurse in Arizona - State Average is $34.42.

The average bonus of a(n) Medical Claims Review Nurse in Arizona - State Average is $1,167.00.

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 Arizona - State Average

Utilization Review Nurse - Phoenix, AZ

Health Choice

Review medical records and claims data for acute and sub-acute levels of care. Claim reviews are completed in a timely manner....

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Utilization Claims Review Nurse - Phoenix, AZ

Health Choice

Provide assistance to Utilization Review Nurses:. The Utilization Claims Review Nurse reviews and analyzes medical record and claims data, utilizing and...

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Medical Claims Review Nurse - Phoenix, AZ

Care1st Health Plan Arizona

The Medical Claims Review Nurse performs comprehensive medical record and claims review on retrospective, prior period coverage, DRG and outlier claims to make...

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Medical Claims Review Nurse - Arizona

Care1st Health Plan

The Medical Claims Review Nurse performs comprehensive medical record and claims review on retrospective, prior period coverage, DRG and outlier claims to make...

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RN-Telephonic Triage QA - Phoenix, AZ

ASHTON TIFFANY, LLC

The goal of utilizing the nurse triage services is to provide appropriate care advice and potentially decrease the number of workers' compensation claims and...

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