- 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
- Elevance Health (Independence, OH)
- …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
- 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