- 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 (East Syracuse, NY)
- ** Clinical Review Nurse I - Medicare...health information is strongly preferred. + Processing Part B clinical claims in MCS. + Experience with ... 5 pm EST or CST. Hours are flexible.** The ** Clinical Nurse Reviewer I** is responsible for...desired but not required. + Prior experience with claim review of Medicare helpful. + Proficient in basic math… 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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …guidelines. This position requires strong clinical and medical coding skills to review claims for medical necessity, appropriate coding, and pricing of ... healthcare? Bring your true colors to blue. The RoleThe Claims Nurse Reviewer is responsible for reviewing...and Medical and Payment Policy teams. Key Responsibilities: + Review pending claims utilizing sound clinical… 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
- Banner Health (AZ)
- …supporting a culture focused on enhancing processes and maximizing efficiency with the review and management of claims and litigation matters. Paralegal, ... the RMIS database when requested. Assists in the initial review and assessment of claims , pre-litigation and...team. PREFERRED QUALIFICATIONS Registered nurse with active licensure with clinical experience is preferred. In-house claims or… more
- Insight Global (Eden Prairie, MN)
- …hands-on medical coding role, rather more of a reviewer type position. Perform clinical review of professional claims vs. medical records to determine if ... - Clinical Case Reviews -75% - Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or… more
- Sedgwick (Dallas, 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)
- …orchestration. As our ** Clinical Coding Appeals Nurse** , you will help review and interpret medical records to draft appeals of denied and underpaid claims ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse:** + Review and...and interpret medical records to appeal denied and underpaid claims . + Apply clinical judgment and knowledge… more
- L'Oreal USA (Clark, NJ)
- …or products), in advertising claims substantiation is required. + Experience in clinical claims , instrumental claims , and/or consumer claims ... visits to the French R&D laboratories, attendance at meetings and seminars, review of patents and contracts with universities and testing organizations. + Lead,… 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
- Humana (Columbus, OH)
- …clinical policy development, prior authorization requirement definition, prior authorization and claims review , UM vendor management, analytics / reporting) + ... care in specific clinical categories + Work hand-in-hand with Clinical Strategy, Clinical Operations, Claims , Markets to shape new initiatives, providing… 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 (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
- University of Michigan (Ann Arbor, MI)
- …analytics The MCT2D data analyst will work with multiple different data types including clinical data, claims data, survey data, and data from remote patient ... quality improvement programs whose goals are to improve quality, safety, and clinical outcomes for specific healthcare procedures or medical conditions across the… 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
- Dignity Health (Rancho Cordova, CA)
- …communication and computer skills. - Considerable interpersonal skills. **Preferred Qualifications:** - Clinical claims review experience highly desired. - ... Analysis of available data to measure individual and team performance, clinical program performance, team processes and compliance are essential. Working with… more
- Hawaii Pacific Health (Kailua Kona, HI)
- …primary care physicians under Hawai'i Health Partners. In this role, you will review patients' available data, including clinical / claims history, outpatient ... and education. The Population Outreach team provides administrative support and clinical data monitoring to support Hawaii Pacific Health Partners, a physician-led… more