- Molina Healthcare (Boise, ID)
- …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
- Lincoln Financial Group (Boise, ID)
- …organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you ... a clinical resource for Group Protection benefit specialists and claim professionals. You will evaluate medical information...this role you will provide coaching and guidance to claims regarding medical management **What you'll be… more
- R1 RCM (Boise, ID)
- …working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid claims . + Apply clinical judgment and ... Coding Appeals Nurse ** , you will help review and interpret medical records to draft...and underpaid claims . Every day you will review medical records to ensure appropriate coding… more
- Valor Health (Emmett, ID)
- URGENT CARE PHYSICIAN ASSISTANT / NURSE PRACTITIONER - PRN Emmett, ID (http://maps.google.com/maps?q=1202+E+Locust+St+Emmett+ID+USA+83617) Apply Description Position ... Title: Advanced Practice Provider ( Nurse Practitioner, Physician Assistant) Department: Valor Health Family Medicine...of Nursing Guidelines. C. Accurately and timely document for medical necessity, as defined by Medical Staff… more
- Molina Healthcare (Boise, ID)
- … claims with corresponding medical records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines, and provider ... policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or… more
- CVS Health (Boise, ID)
- …Direct and oversee complex reviews. Ensure timely and accurate reporting of review findings and coordinate with investigative to take appropriate action. Conducts ... detection, investigation, or auditing In-depth knowledge of healthcare systems, claims processing, and regulatory requirements related to healthcare fraud.… more