- Molina Healthcare (Akron, OH)
- …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
- CommuniCare Health Services (Akron, OH)
- …and ensuring coding and documentation are accurate, appropriate, and demonstrate medical necessity. Submission of claims , pre-certifications, processing of ... and compliant billing and coding. + Prepare and submit claims via electronic billing system. + Ensure medical...EOB's, electronic EDI reports, electronic remits. + Work with nurse practitioners and other medical personnel to… more
- Molina Healthcare (Akron, OH)
- … 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 (Akron, OH)
- …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