- J&J Family of Companies (Skillman, NJ)
- …Develop and substantiate claims , formulate clinical strategies, perform clinical trial related activities, review and approve product labels and ... Senior Scientist EH Claims / Clinical - 2407018022W **Description** Kenvue is currently recruiting for: **Senior Scientist EH Claims / Clinical ** This… more
- L'Oreal USA (Clark, NJ)
- …Claims and Country Scientific Directors. + Act as Principal contact person in the claims review in assigned areas, from inception to launch and beyond. + ... Perform legal and compliance review of advertising copy in all forms of media... claims substantiation is required. + Experience in clinical claims , instrumental claims , and/or… more
- Elevance Health (Harrisburg, PA)
- …send you a check, or ask you for payment as part of consideration for employment. ** Clinical Review Nurse I (US)** + Job Family: MED > Licensed Nurse + Type: ... Houston + Maine, South Portland + Wisconsin, Waukesha **Description** ** Clinical Review Nurse I** National Government Services...health information is strongly preferred. + Processing Part B clinical claims in MCS. + Experience with… more
- CareOregon (Portland, OR)
- …program and assist with developing treatment plans as assigned. + Analyze CCO clinical claims data to identify prescribing trends and develop interventions to ... and maintain up-to-date list of credentialed pharmacists. + Regularly review and recommend CPT codes for clinical ...principles of evidence-based medicine + Ability to design and review pharmacy claims analysis/reports according to specific… more
- Community Clinic Inc. (Silver Spring, MD)
- … Claims Specialist to serve as a financial resource in support of the clinical services provided. The Claims Specialist will assure that services are promptly ... accordance with all applicable Federal, State, and local regulations and guidelines, that claims are adjudicated in a timely manner, and customer's needs are met in… more
- Elevance Health (Norfolk, VA)
- …+ ClaimsXten or Timber experience preferred + SQL + Prior experience with clinical code editing applications. + Claims processing experience. + Experience with ... you for payment as part of consideration for employment. **Rating/ Claims System Analyst** + Job Family: IFT > IT...Disability / Veteran Please use the links below to review statements of protection from discrimination under Federal law… more
- Point32Health (MA)
- …**- what you will be doing** **Utilization Management** + Performs clinical review of prospective, concurrent, and retrospective coverage requests ... and concerns. + Supports the provider inquiry line for peer-to-peer discussions. + Performs clinical review of expedited and standard appeals for all lines of… more
- HUB International (Chicago, IL)
- …data analytics system (Infused Analytics [IA]), including deep dive catastrophic claims reviews, clinical note interpretation, and summarization of complex ... utilization, quality metrics, and creating strategies to improve clinical KPIs. + Manages the HUB International claims...stop loss claimants. + Collaborates with stop loss partner's clinical teams and meets regularly to review … more
- Access Dubuque (Dubuque, IA)
- …the need for absence from work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and ... Disability Clinical Specialists **Sedgwick** 1 Positions ID: R49038 Posted...completes medical review of all claims to ensure information substantiates disability. + Provides clear… more
- Sedgwick (Austin, TX)
- …the need for absence from work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and ... completes medical review of all claims to ensure information substantiates disability. + Provides clear and appropriate follow-up recommendations for ongoing… more
- R1 RCM (Boise, ID)
- As a ** Clinical Coding Appeals Author** , you will help review and interpret medical records to draft appeals of denied and underpaid claims . Every day you ... and interpret medical records to appeal denied and underpaid claims + Apply clinical judgment and knowledge...for DRG downgrades performed as a result of a Clinical Validation Review by an insurer or… more
- Serco (Washington, DC)
- …in direct communication with the Program Director, Assistant Program Director for Medical Claims Review , Data Processing Reviewers, and CMS PERM staff, as ... of strong supervisory experience and subject matter expertise in claims data processing review for the Medicaid...(3) years of supervisory or managerial experience in medical claims or clinical data management; + Preferably… more
- Serco (Washington, DC)
- …ideally brings combination of supervisory experience and subject matter expertise in claims data processing review for the Medicaid and Children's Health ... claims processing systems and processes to ensure quality claims data review to meet requirements of...experience in a supervisory or managerial role in medical claims or clinical data management; + A… more
- Kelly Services (Washington, DC)
- …required as this exam will include only a general examination, and medical record review if requested on the initial VA request.** + **Travel is required with this ... good standing and free of significant sanctions or malpractice claims ** + **Active Malpractice Insurance** + **Preferred LLC Business...means our team of expert Government and Science & Clinical recruiters will have access to your profile, making… more
- Boehringer Ingelheim (Ridgefield, CT)
- …to assess biostatistics and clinical studies with respect to the support of clinical claims . + Must have excellent written and verbal skills as the role ... **Description** Review promotional claims and materials for...Knowledge and understanding of drug development, including phases of clinical studies, general requirements for drug marketing approval and… more
- Providence (Portland, OR)
- … teams: + Prior-authorization (PA) + Concurrent Review (CCR) + SNF + Clinical Claims + Provider Reconsideration + Member Appeals + Medical + Coding + ... for all lines of business + Responsible for ensuring service review requests and clinical inquiries are complete and adjudicated to meet regulatory and… more
- Providence (Seattle, WA)
- …the function. Direct responsibility and oversight for divisional pre-service and post-service utilization review , clinical claims audit, clinical appeals ... CERT, ADR regulatory denials. Implements appropriate procedures to mitigate clinical commercial and government denials. + Maintains strong relationships throughout… more
- Swedish Health Services (Edmonds, WA)
- …Assists with information to support appeal of any business office denials. Researches clinical denial claims and writes appeal letters. * Documents findings in ... the chance to focus on what really matters - our patients.** Provides clinical case management functions via a collaborative process that transitions patients to… more
- HCA Healthcare (Richmond, VA)
- … clinical documentation issues and revenue opportunities. Provides charge review results and develops and coordinates educational in-services for facility staff ... and resolve specific billing edits that require an RNs clinical expertise and that are delaying claims ...we encourage you to apply for our Revenue Integrity Clinical Analyst RN opening. We promptly review … more
- The Cigna Group (Bloomfield, CT)
- …Healthcare Common Procedure Coding System (HCPCS) codes]. **Preferred Requirements** + Recent Utilization Review or Claims Review experience. + Knowledge of ... it relates to Payment Integrity Program Claim disputes (ie Claims XTEN, Prepay Vendors, etc.). + Utilize clinical... Claims XTEN, Prepay Vendors, etc.). + Utilize clinical data and/or coding guidelines, medical information, benefit plan,… more