- Molina Healthcare (Vancouver, WA)
- …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 (Olympia, WA)
- …for conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You'll ... through phone and e-mail to gather information regarding the Short Term Disability claim . + Collaborating with fellow case managers, nurse case managers and… more
- Lincoln Financial Group (Olympia, WA)
- …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 (Seattle, WA)
- …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 (Seattle, WA)
- ** Nurse and CPC - Clinical Fraud Investigator II -...control. + Review and conducts analysis of claims and medical records prior to payment. Researches ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Molina Healthcare (Spokane, WA)
- … 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 (Seattle, WA)
- …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
- United Therapeutics (Olympia, WA)
- …reimbursement support, patient support programs, field reimbursement managers, patient navigators and nurse educators + Review Needs Assessment Forms related to ... and biotech industry, including FDA advertising and promotion, False Claims Act, Anti-Kickback Statute, OIG Guidance, the PhRMA Code,...+ Serve as the Legal representative on the Company's medical communications review , including review … more
- Veterans Affairs, Veterans Health Administration (Spokane, WA)
- …care of the dermatology patient. Help supervise and train physician assistants, nurse practitioners, residents, and medical student trainees. Perform the ... available staffing, which includes physicians, consultant and attendings, physician assistants/ nurse practitioners, residents, and students. Responsibilities Duties include but… more
- Veterans Affairs, Veterans Health Administration (Spokane, WA)
- Summary The incumbent serves as Section Chief for Psychiatric Services and Medical Director for the Behavioral Health Service (BHS) at VAMC Spokane. In this role, ... Chief of Behavioral Health Service in all matters related to psychiatric and medical care. Responsibilities Duties include but are not limited to: Providing clinical… more
- Veterans Affairs, Veterans Health Administration (Spokane, WA)
- …are not limited to: Coordinating and providing clinical oversight of physicians, nurse practitioners, and other professionals who provide or support provision of ... of all supervisees. Promoting clinical training and development of acute and specialty medical staff and those who support provision of psychiatric care. Assisting … more
- CVS Health (Olympia, WA)
- …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