- CVS Health (Franklin, TN)
- …timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and ... make health care more personal, convenient and affordable. **Position Summary** Performs claim documentation review , verifies policy coverage, assesses claim … more
- Rising Medical Solutions (Chicago, IL)
- …With offices, providers, and case managers nationwide, RISING provides comprehensive medical claims solutions to our valued clients: insurance carriers, ... experience in acute care, surgery and/or orthopedic + Workers' Compensation medical bill review experience a major plus + Understanding of CPT and ICD-10… more
- ConvaTec (South Easton, MA)
- …guideline requirements needed to set up and maintain client accounts of 180 Medical . + Review received documentation to determine insurance requirements are met. ... records within Medtrack, an internal database, to support client services and claim payment processes. + Support Team Supervisor on miscellaneous projects + Must… 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...Claims Auditing, Medical Necessity Review and Coding experience +… more
- Zurich NA (Schaumburg, IL)
- Medical Bill Review Assoc II 117151 Zurich is currently looking for a Medical Bill Review Assoc II for our Schaumburg, IL office. This position with ... will handle research and resolve technical problems in the review of medical bills to ensure the...methodology, and/or special client instructions. At Zurich North America Claims we acknowledge that work life-balance and flexibility are… more
- Takeda Pharmaceuticals (Exton, PA)
- …knowledge. **Job Description** About the role: Join Takeda as a Senior Manager, US Medical Ad/Promo Regulatory Review where you will serve as an internal expert ... including additional product responsibilities. As part of the US Medical team, you will report to the Director, Ad/Promo...comments and any other interactions regarding use of promotional claims for assigned products. + Ensure review … more
- The Arora Group (Bethesda, MD)
- …providers in gathering clinical information and may also provide education on the medical review process. + The Contractor performing as the License Practical ... Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse...and validity of the item(s) supplied in a valid claim through the use of medical policy… more
- City of New York (New York, NY)
- …appropriate, negotiate and settle claims within delegated monetary authority level; 7) Review medical providers and law firms to ensure all entities are in ... not limited to: 1) Manage individual No-fault files and review investigation reports, medical reports, bills and...to gather information relevant to the investigation of the claim ; 10) Investigate, identify, and report fraudulent claims… more
- Travelers Insurance Company (Melville, NY)
- …This position is responsible for handling Personal and Business Insurance First Party Medical claims from the first notice of loss through resolution/settlement ... you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided...Proactively manages the process to ensure proper payment, (ie review medical bills and medical … more
- Travelers Insurance Company (West Bridgewater, MA)
- …This position is responsible for handling Personal and Business Insurance First Party Medical claims from the first notice of loss through resolution/settlement ... you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided...Proactively manages the process to ensure proper payment, (ie review medical bills and medical … more
- Travelers Insurance Company (St. Paul, MN)
- …direct supervision, this position is responsible for: Reviewing/evaluating, approving and processing Medical Only claims with: No lost time beyond statutory ... you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided...guidelines, medical position statements, etc.). + Coordinate medical treatment as appropriate: + Review , approve… more
- The County of Los Angeles (Los Angeles, CA)
- …direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of ... for and the effective conduct of the system to review patients' medical charts to ascertain the...complete this questionnaire completely and correctly. The experience you claim in this supplemental questionnaire must be consistent with… more
- ManpowerGroup (Columbia, SC)
- …compliance and ensure ongoing process improvement. **Qualifications:** + Strong understanding of medical claims review processes, medical necessity ... **Job Title: Medical Claims Reviewer** **Pay Rate:23/Hr (REMOTE... necessity and benefit guidelines. **Key Responsibilities:** + Perform medical claim reviews and make reasonable charge… more
- Centene Corporation (Jackson, MS)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. + Supports effective implementation… more
- Centene Corporation (Austin, TX)
- …management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review , quality ... medical review of complex, controversial, or experimental medical services. Supports effective implementation of performance improvement initiatives for… more
- Providence (ID)
- …the best people, we must empower them.** **Providence is calling a Sr. Medical Malpractice Claims Manager - Professional Liability who will:** **Investigate, ... Program:** + Communicate with patients, claimants, caregivers, providers, leadership + Review and analyze medical records, interview witnesses, assist with… more
- US Tech Solutions (Columbia, SC)
- …following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a reasonable charge ... indicated protocol sets or clinical guidelines. Provides support and review of medical claims and...families/caregivers. Reviews first level appeal and ensures utilization or claim review provides thorough documentation of each… more
- Point32Health (Canton, MA)
- …of our organization. **Key** **Responsibilities/Duties** **- what you will be doing** + Review and audit medical claims to ensure accuracy, completeness, ... crucial role in our organization by reviewing and auditing medical claims to ensure compliance with policies,...**:** + Required (minimum): 5-7 years of experience in medical claim auditing, healthcare compliance, or a… more
- Mount Sinai Health System (New York, NY)
- …practices; routes requests to medical leadership when appropriate + Documents authorization review for medical and pharmacy claims . + Prepares case ... related documents required to modify and/or add necessary services. + Performs continuing review of medical records; analyzing data trends and implementing best… more
- Martin's Point Health Care (Portland, ME)
- …policies, and internal guidelines for medical necessity reviews. + Manage the review of medical claims disputes, records, and authorizations for billing, ... medical necessity reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental… more
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