Berlin, Germany · Remote Solely
$81k–$121k/yr
Company Overview Shriners Children’s is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embraci…
Skills: Denials management, Appeals, Clinical documentation, Medical necessity, Revenue cycle
Berlin, Germany · Remote OK
$158k–$237k/yr
Company Overview Shriners Children’s is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embraci…
Skills: Pediatric Radiology, Diagnostic Imaging, Radiography, Ultrasound, CT Imaging
Berlin, Germany · Remote Solely
$67k–$100k/yr
Company Overview Shriners Children’s is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embraci…
Skills: Denials Management, Revenue Cycle Management, Epic PB Resolute, Data Analysis, Claims Denials
Berlin, Germany · Remote OK
$89k–$134k/yr
Company Overview Shriners Children’s is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embraci…
Skills: Workday HCM, Workday Configuration, Business Process Management, Data Accuracy, Troubleshooting
Berlin, Germany · Hybrid
Job Description Dein Herz schlägt für das Retailgeschäft und Du möchtest aktiv dabei sein, unser Geschäft weiterzuentwickeln? Unter der Marke Circle K betreuen wir Convenience-Shops in 1.200 Servicestationen deutschlandw…
Skills: Customer Service, Complaint Management, Root Cause Analysis, Conflict Resolution, Communication Skills
Berlin, Germany · Hybrid
Job Description: *English version below* Team/Bereich Die Abteilung Risk trägt die grundlegende Verantwortung für den Schutz der Bank. Mit der gruppenweiten Verantwortung für das Management und die Kontrolle von Kredit-,…
Skills: Credit Risk Modeling, LGD Calibration, CCF Calibration, SAS, Python
Berlin, Germany · Hybrid
Unser Ziel ist eine Solaranlage auf jedem Dach, ein Speicher in jedem Haus und ein E-Auto in jeder Garage. Enpal macht das möglich mit einer integrierten Gesamtlösung für dezentrale Energie – von Solaranlage und Batterie…
Skills: Project Management, Operations Management, Stakeholder Management, Process Optimization, People Management
Berlin, Germany · Hybrid
Das ist das Arbeitsumfeld: Als Account Executive (m/w/d) im Regionalvertrieb agierst Du prozessberatungsorientiert mit dem Fokus auf den Ausbau von Kundenpotenzialen sowie die Segmententwicklung von Kanzleien und erschli…
Skills: Sales, Process Consulting, Customer Acquisition, Presentation Skills, Needs Analysis
Berlin, Germany · Hybrid
Unser Ziel ist eine Solaranlage auf jedem Dach, ein Speicher in jedem Haus und ein E-Auto in jeder Garage. Enpal macht das möglich mit einer integrierten Gesamtlösung für dezentrale Energie – von Solaranlage und Batterie…
Skills: Project Management, Operations Management, Stakeholder Management, Process Optimization, People Management
Berlin, Germany · On-site
TK Maxx At TJX Europe, every day brings new opportunities for growth, exploration, and achievement. You’ll be part of our vibrant team that embraces diversity, fosters collaboration, and prioritises your development. Whe…
Skills: Customer Service, Cashiering, Merchandising, Inventory Management, Teamwork
Berlin, Germany · Hybrid
Unser Ziel ist eine Solaranlage auf jedem Dach, ein Speicher in jedem Haus und ein E-Auto in jeder Garage. Enpal macht das möglich mit einer integrierten Gesamtlösung für dezentrale Energie – von Solaranlage und Batterie…
Skills: Project Management, Operations Management, Stakeholder Management, Process Optimization, People Management
Berlin, Germany · Remote OK
HEY THERE We’re looking for a Senior Controller to join Yazio and take full ownership of our controlling function as we continue to scale. You will bring structure, rigour and depth to our monthly close, accounting opera…
Skills: Monthly Close, Technical Accounting, Internal Controls, Financial Reporting, DATEV
Berlin, Germany · On-site
Das erwartet Sie bei uns: Sie verantworten die optimale Einsatzfähigkeit unserer Fahrzeuge und sorgen für einen technisch einwandfreien Zustand. Dank Ihnen sind unsere Fahrzeuge stets im besten Zustand und einsatzbereit.…
Skills: Vehicle Maintenance, Technical Troubleshooting, Customer Service, Organization, Independent Working
Berlin, Germany · Hybrid
Unser Ziel ist eine Solaranlage auf jedem Dach, ein Speicher in jedem Haus und ein E-Auto in jeder Garage. Enpal macht das möglich mit einer integrierten Gesamtlösung für dezentrale Energie – von Solaranlage und Batterie…
Skills: Lead Steering, Sales Process Optimization, Sales Funnel Scaling, KPI Analysis, Business Process Management
Berlin, Germany · Hybrid
Unser Ziel ist eine Solaranlage auf jedem Dach, ein Speicher in jedem Haus und ein E-Auto in jeder Garage. Enpal macht das möglich mit einer integrierten Gesamtlösung für dezentrale Energie – von Solaranlage und Batterie…
Skills: Lead Steering, Sales Process Optimization, Sales Funnel Management, KPI Analysis, Data-Driven Decision Making
Berlin, Germany · Hybrid
Unser Ziel ist eine Solaranlage auf jedem Dach, ein Speicher in jedem Haus und ein E-Auto in jeder Garage. Enpal macht das möglich mit einer integrierten Gesamtlösung für dezentrale Energie – von Solaranlage und Batterie…
Skills: Lead Steering, Sales Process Optimization, Sales Funnel Management, KPI Analysis, Business Process Management
Berlin, Germany · On-site
Freelance-Möglichkeit – Bauleiter / Bauüberwacher Fundamentbau Windenergie (m/w/d) Wir bereiten derzeit ein potenzielles Großprojekt im Bereich Onshore-Windenergie in Deutschland vor. Der Projekteinsatz wird voraussichtl…
Skills: Construction Management, Construction Supervision, Concrete Construction, Foundation Construction, Reinforced Concrete Construction
FoodLabsBerlin, Germany · On-site
About FoodLabs FoodLabs is Europe's leading early-stage VC and venture studio, backing founders who are shaping the future of food, health, and wellness. We believe the next wave of consumer companies will redefine nutri…
Skills: Brand Storytelling, Go-to-market Strategy, Digital Marketing, Community Management, Unit Economics
Berlin, Germany · On-site
About us We are EnduroSat! A fast-growing space scale-up at the forefront of satellite innovation, specializing in advanced software-flexible satellites for commercial, governmental, and scientific endeavors. This is mor…
Skills: Systems Engineering, Requirements Decomposition, Satellite Design, Nanosats/Smallsats, Requirements Writing
Berlin, Germany · On-site
About us We are EnduroSat! A fast-growing space scale-up at the forefront of satellite innovation, specializing in advanced software-flexible satellites for commercial, governmental, and scientific endeavors. This is mor…
Skills: 3D CAD, SolidWorks, NX, Mechanical Design, Technical Documentation
Berlin, Germany • Remote Solely
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The Denials Management Appeals Nurse manages medical denials by conducting comprehensive clinical documentation reviews and writing compelling arguments for appeals. They are responsible for maintaining knowledge of payor criteria and ensuring compliant appeal filings in accordance with contractual requirements.
Candidates must have at least 5 years of clinical healthcare experience, including 3 years of anesthesia experience and a current RN license. A high school diploma or GED is required, while a BSN and case management certification are highly desired.
Shriners Children’s is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families.
With 20+ hospitals, outpatient clinics, ambulatory care centers and outreach locations across the globe, we provide excellent care to children up to age 18 regardless of their family’s ability to pay or insurance status. Please click here to learn more about our locations.
The Denials Management Appeals Nurse (Anesthesia) is responsible for managing our medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The Denials Management Appeals Nurse (Anesthesia) will utilize their clinical background to address the clinical denials, as well as write sound, compelling factual arguments for appealing denials.
The Denials Management Appeals Nurse (Anesthesia) is also responsible for maintaining a detailed knowledge of Third Party Payors and Governmental Payors clinical/medical necessity criteria, as well as filing compliant appeals in accordance with Third party and governmental contracts
Performs a review of assigned cases comparing the bill to the medical record.
Performs a detailed comparison of charges to documentation to ensure services documented have been captured through the charge process
Performs a detailed comparison of charges to documentation to ensure services not documented are not charged.
Reviews documentation to ensure that services typically performed with specific procedures are being documented so that charge capture may occur
Review findings with the hospital representatives and obtains an agreement on the discrepancies.
Demonstrates tact and understanding in handling problems, has a good rapport with hospital and corporate staffs.
Follows up on appeals in a timely fashion to ensure that cases are completed.
Re-checks mathematical computations before finalizing letter and report.
Updates status of all cases assigned on minimum weekly basis
Informs supervisor of any changes, problems, or concerns that arise at a facility.
In the event of a dispute with the requesting party’s audit findings, files an appeal with the third party or governmental payor
Analyzes and interprets all medical necessity/clinical denials from third party payors or governmental payors.
Files appeals based on medical documentation and interpretation of medical necessity guidelines or InterQual criteria.
5 years of clinical healthcare/hospital experience
3 years of related Anesthesia experience
Third Party Payor Appeals/Revenue Cycle experience
Current RN license in State of employment
Working experience with Utilization Review activities and general knowledge of TJC, PRO, and other regulatory bodies.
High School Diploma/GED
Bachelor’s degree - BSN highly desired
Case Management certification
Experience reviewing hospital and professional claims, denials and EOB's, appealing claims and working on claims in an audit
Experience with Epic, Craneware, Waystar, software and applications
Shriners Hospitals for Children - Canada
Établi à Montréal (Québec) depuis 1925, l’Hôpital Shriners pour enfants – Canada est un centre de soins de courte durée, bilingue, dont les soins pédiatriques orthopédiques ultraspécialisés traitent des troubles complexes tels que, l’ostéogenèse imparfaite et les anomalies graves de la colonne vertébrale ou des membres. Il offre également la chirurgie reconstructive et la réadaptation. Des enfants du Canada, des États-Unis et du monde entier ont bénéficié des recherches d’avant-garde et des traitements novateurs de l’hôpital. Dans sa pratique clinique, en enseignement et en recherche, l’hôpital est entièrement dédié à la poursuite de l’excellence et de l’innovation tout en veillant à ce que les patients et leur famille évoluent dans un environnement empreint de compassion et qui soit centré sur la famille. Grace à la télémédecine et à ses cliniques satellites, l’hôpital est également bien enraciné dans les diverses communautés du Canada. Built in 1925 in Montreal, Quebec, the Canada Shriners Hospital is a bilingual, short term, acute care centre providing pediatric orthopedic ultraspecialized care for complex disorders such as osteogenesis imperfecta (brittle bone disease), severe spinal and limb anomalies, reconstructive surgery and rehabilitation. Children from across Canada, the U.S. and around the world have benefited from the hospital’s groundbreaking research and innovative treatments. The hospital is committed to excellence and innovation in clinical practice, research and education and to ensuring patients and their families are treated in a caring, family-friendly environment. The hospital is also present in communities across Canada thanks to telemedicine, outreach clinics. • Écart dans la longueur des membres • Scoliose et déformations vertébrales • Spasticité et paralysie cérébrale • Pied Bot • Malformations de la main • Arthrogrypose • Blessures sportives • Troubles métaboliques et héréditaires des os • Conditions neuromusculaires • ...
Offices: 1003, Decarie Blvd., Montreal, Quebec H4A 0A9, CA
