• Medical Claim Review

    Molina Healthcare (St. Petersburg, FL)
    …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
    Molina Healthcare (01/18/25)
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  • Clinical Review Auditor REMOTE

    Community Health Systems (Sarasota, FL)
    (Full-Time, Remote) The Clinical Review Auditor is a professionally licensed nurse /LPN who is responsible for effectively managing the denial/appeal process via ... the performance of comprehensive analytic reviews of clinical and claim documentation. The CRA will perform triage, determine payment viability; and draft and submit… more
    Community Health Systems (01/15/25)
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  • Investigator, Coding SIU (Remote)

    Molina Healthcare (St. Petersburg, FL)
    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
    Molina Healthcare (12/15/24)
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  • Medical Director

    Molina Healthcare (St. Petersburg, FL)
    …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
    Molina Healthcare (01/21/25)
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