- 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
- Lincoln Financial Group (Frankfort, KY)
- …for conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You'll ... to bring on a highly motivated Long-Term Disability (LTD) Claims Specialist to our claims organization. **What...and consulting physicians to make appropriate, ethical, and timely claim determinations. * Reviewing complex medical records… more
- Lincoln Financial Group (Frankfort, KY)
- …for conducting initial and ongoing interviews with claimants, obtaining and reviewing medical records, and making timely and ethical claim determinations. You'll ... are excited to bring on a highly motivated **Group Claims Specialist** to support our ever-growing claims ...managers, and consulting physicians to make appropriate and timely claim determinations. + Reviewing complex medical records… more
- Lincoln Financial Group (Frankfort, KY)
- …for conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You'll ... professionals through phone and e-mail to gather information regarding Short Term Disability Claims , Family Medical Leaves, and state benefits when applicable. +… more
- Highmark Health (Frankfort, KY)
- … review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate level of payment and ... rejection and the proper action to complete the retrospective claim review with the goal of proper...in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or… more
- Humana (Frankfort, KY)
- …action. + Complete medical record reviews + Assess discharge plans + Review and extract information from claims + Complete documentation for Quality Reviews ... licensed in a Compact State** The Utilization Management Behavioral Health Nurse completes medical record reviews from medical records sent from Behavioral… more