- Point32Health (Canton, MA)
- …about who we are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** As a Medical Audit Claim Reviewer , you will play a ... you will be doing** + Review and audit medical claims to ensure...**:** + Required (minimum): 5-7 years of experience in medical claim auditing, healthcare compliance, or a… more
- Molina Healthcare (Lexington, KY)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...decision making pertinent to clinical experience + Documents clinical review summaries, bill audit findings and … more
- Zelis (Morristown, NJ)
- … claims progression + Complete claims processing after the Clinical Bill Review and Audit analysis is completed. + Assist in appeals process as necessary ... Position Overview: At Zelis, the Itemized Bill Review Facility Reviewer is responsible for...proper billing guidelines. They will work closely with Expert Claims Review and Concept Development staff to… more
- Zelis (Morristown, NJ)
- …as it compares with medical records and coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest possible ... responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines...provider preferred. + 2+ years of auditing or performing claims review in specialty pharmacy claims… more
- Zelis (TX)
- …Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest ... plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records...concepts to expand the DRG product. + Manage assigned claims and claim report, adhering to client… more
- Rising Medical Solutions (Chicago, IL)
- …of medical records and medical billing statements, and will: + Audit medical and billing records to determine if services provided are reasonable, ... in acute care, surgery and/or orthopedic + Workers' Compensation medical bill review experience a major plus...offices, providers, and case managers nationwide, RISING provides comprehensive medical claims solutions to our valued clients:… more
- Elevance Health (Columbus, OH)
- … chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise, ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… more
- Elevance Health (Columbus, OH)
- …procedures. + Investigates potential fraud and over-utilization by performing the most complex medical reviews via prepayment claims review and post payment ... of utilization and/or fraudulent activities by health care providers through prepayment claims review , post payment auditing, and provider record review… more
- LogixHealth (Bedford, MA)
- Location: On-Site in Bedford, MA This Role: As a Claims Specialist, you will work with internal teams to provide cutting-edge solutions that will directly improve ... fast-paced, collaborative environment and will bring your expertise to review and carry out processes on all out of...and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,… more
- Old Dominion Freight Line (Thomasville, NC)
- …as needed + Review financial information and determining settlement of downtime claims + Audit and process independent adjuster invoices + Write settlement, ... attorneys and medical lien providers + Scan claim documents into the Liability Claims System,... Claims System, and ensuring correct classification and claim number of each document scanned + Review… more
- GAF (Parsippany, NJ)
- …training. + Establish and report claims evaluation turnaround metrics to ensure claim review , evaluation, and final disposition in a timely fashion, and ... analysis and reporting processes related to identifying, prioritizing the pending claim review backlog, and reporting field issues that require collaboration… more
- Metropolitan Council (St. Paul, MN)
- …+ Participate in bi-annual claims meetings with internal departments. + Review medical , legal, and miscellaneous invoices to determine if reasonable and ... to our organization and the Twin Cities region: TheWorkers' Compensation Claims Representativewill administer Minnesota lost time and medical -only Workers'… more
- Sedgwick (West Hills, CA)
- …reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality ... authority of the individual examiner. + Monitors third party claims ; maintains periodical review of litigated ...claim status; and provides written resumes of specific claims as requested by client. + Assures that direct… more
- Sedgwick (Long Beach, CA)
- …reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements and quality ... the authority of individual PL Specialists. + Maintains periodic review of claims that are litigated, sensitive,...claim status; and provides written resumes on specific claims as requested by client. + Maintains frequent diaries… more
- Sedgwick (San Diego, CA)
- …reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality ... authority of the individual examiner. + Monitors third party claims ; maintains periodical review of litigated ...claim status; and provides written resumes of specific claims as requested by client. + Assures that direct… more
- Sedgwick (Syracuse, NY)
- …reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality ... authority of the individual examiner. + Monitors third party claims ; maintains periodical review of litigated ...claim status; and provides written resumes of specific claims as requested by client. + Assures that direct… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …Diploma or equivalent required **Work Experience** + 6 months of experience in medical claims or health insurance-related customer service or the successful ... plans) in order to process both coordinated and non-coordinated claims correctly. Requesting of medical records may...is not limited to, the coordination of benefits (COB), medical record requests, etc. + Review quality… more
- Prime Healthcare (Ontario, CA)
- …of Claims for all Prime Healthcare's self-insured Employee Health Plans. Through in-depth audit and review of Claims data, the VP will identify financial ... members to join our corporate team! Responsibilities TheVice President of Health Plan Claims and Operations is responsible for the development and execution of … more
- Henry Ford Health System (Detroit, MI)
- …Provide key system role in workers compensation and employers liability claims review , investigation, management and disposition, including financial mitigation ... of indemnity payment and claim defense costs and management of System reputation Will...System reputation Will work under the guidance of Senior Claims Managers, Director of Insurance, and Vice President, to… more
- Veterans Affairs, Veterans Health Administration (Oklahoma City, OK)
- …quality control tests, records, and corrective actions, the annual physicist's survey, and medical audit and outcomes analysis, meet the required standards 21 ... by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities VA offers a comprehensive total rewards… more