- Molina Healthcare (Des Moines, IA)
- …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
- Access Dubuque (Dubuque, IA)
- Claims Processing Representative **Grand River Medical Group** 1 Positions ID: 1405087 Posted On 01/17/2025 **Job Overview** ** Claims Processing ... Position located in Dubuque, IA; telecommuting options available Grand River Medical Group is seeking an experienced Claims Processing Representative… more
- Lincoln Financial Group (Des Moines, IA)
- …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
- Elevance Health (West Des Moines, IA)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… more
- Elevance Health (Des Moines, IA)
- ** Nurse /CPC - Clinical Fraud Investigator Senior - SIU Fraud...control. + Review and conducts analysis of claims and medical records prior to payment. + ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- JBS USA (Marshalltown, IA)
- …screen. Review physician reports on employee's health, workers' compensation insurance claims , medical restrictions on employee's work and the policies and ... 3rd Shift Hours: 3rd shift General Description: Respond to the scene of medical emergencies occurring on company property and administer first aid and/or medical… more
- Access Dubuque (Dubuque, IA)
- …solution-focused. **PRIMARY PURPOSE** : Provides disability case management and routine claim determinations based on medical documentation and the applicable ... your 2+ years' experience in a office setting or medical experience and grow with us! + A stable...system. + Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims . + Evaluates and… more
- Sedgwick (Dubuque, IA)
- …solution-focused. **PRIMARY PURPOSE** : Provides disability case management and routine claim determinations based on medical documentation and the applicable ... your 2+ years' experience in a office setting or medical experience and grow with us! + A stable...system. + Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims . + Evaluates and… more
- Molina Healthcare (Sioux City, IA)
- … 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
- Veterans Affairs, Veterans Health Administration (Des Moines, IA)
- …issues as requested. As needed, review and co-sign court reports of nurse practitioners if the Medical Director is not available. Complete such reports ... the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible...Whole Health System of care in each of the Medical Centers. This is an approach to healthcare that… more
- Veterans Affairs, Veterans Health Administration (Ottumwa, IA)
- …the outpatient clinic setting. This announcement will be posted as a Physician, Nurse Practitioner, and Physician Assistant for one position. Please apply to the ... Whole Health System of care in each of the Medical Centers. This is an approach to healthcare that...provider. Physicians are expected to provide clinical oversight and review . Supervising or collaborating responsibilities and performance will be… more
- Elevance Health (West Des Moines, IA)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. + ... make an impact:** + Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility; provides authorization for… more
- Trinity Health (Davenport, IA)
- …the risk management plan/program on a day-to-day basis adverse event review , investigation, and escalation. Facilitate Code Events, Apparent Cause Analysis (ACA) ... customers. The Risk Specialist collaborates extensively with local leadership (President, Chief Medical Officer (CMO), Quality and Safety Medical Officer, Chief… more
- Sedgwick (Dubuque, IA)
- …the ADA process for claimants requesting accommodations under the ADAAA; to review complex medical information for temporary and permanent accommodation ... are driven to deliver great work. + Apply your medical /clinical or rehabilitation knowledge and experience to assist in...the next round, a recruiter will be in touch. \# nurse Sedgwick is an Equal Opportunity Employer and a… more
- CVS Health (Des Moines, IA)
- …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