- Hired by Matrix (Summerville, SC)
- …Maintains a safe work environment. Knowledgeable of and follows regulations pertaining to medical necessity and billing as applicable to the job. Completes all ... go the extra mile with our signature Consultant Appreciation Program (CAP) to help them in their future job...healthcare provider? If so, our client is hiring a Medical Tech (Mid Shift). What You'll Do: Performs routine,… more
- Hired by Matrix (Charleston, SC)
- …Maintains a safe work environment. Knowledgeable of and follows regulations pertaining to medical necessity and billing as applicable to the job. Completes all ... and dynamic teams. We even go the extra mile with our signature Consultant Appreciation Program (CAP) to help them in their future job searches. Hired by Matrix has… more
- Integrated Resources, Inc (Springfield, IL)
- …contact for the various groups regarding claims which involves conducting research, obtaining medical records/letters of medical necessity from TMG, reopen ... management, customers, etc. . Comply with HIPAA, Diversity Principles, Corporate Integrity , Compliance Program policies and other applicable corporate and… more
- Public Consulting Group (Cedar Rapids, IA)
- …www.publicconsultinggroup.com . **Responsibilities** + Responsible for coordinating program integrity -related reviews with the medical necessity review ... review manager conducting, directing, or leading medical necessity reviews of Medicaid managed care and/or program... necessity reviews of Medicaid managed care and/or program integrity investigations preferred + Previous supervisory… more
- LifePoint Health (Martinsville, VA)
- …evaluate and measure revenue integrity operations; develops systems to manage medical necessity denials; and develops tracking mechanisms to measure loss ... refers to financial counselors for follow up. . Performs medical necessity check, when appropriate (if not...Illness Bank package for full-time employees . Employee Assistance Program - mental, physical, and financial wellness assistance .… more
- Waystar (AR)
- …hospital inpatient record types, clinical documentation, payer reimbursement methodology, medical necessity criteria, billing requirements and applicable ... **ABOUT THIS POSITION** We are looking for a Revenue Integrity DRG Auditor who has a comprehensive understanding of hospital Revenue Cycle Management. Significant… more
- Trinity Health (Newtown, PA)
- …areas to effectively document services performed and understand relationship of documentation, medical necessity , coding and charging for all services provided. ... **Description:** Trinity Health Mid-Atlantic is looking for an experienced Revenue Integrity Account Specialist to join our team! Hybrid Schedule: Full-time,… more
- AmeriHealth Caritas (Columbus, OH)
- …meetings providing clinical consultation, and holds final authority for recommendations for medical necessity and appropriateness or quality of care decisions. ... care practitioner with oversight of the Quality Improvement (QI) program . The Behavioral Medical Director is an...Medical Director supports the clinical department in applying Medical Necessity Criteria, to render determinations to… more
- Magellan Health Services (Albuquerque, NM)
- …including regular involvement in the case management of at-risk cases and medical necessity decisions. Follows high risk cases throughout treatment continuum ... management plans. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure...implementation, training and supervision of the use of the medical necessity criteria. + Along with the… more
- CVS Health (Springfield, IL)
- …of most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) ... most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental...Suite Education * Must be graduate of an accredited Medical School and Residency Program * ABMS or… more
- University of Utah (Salt Lake City, UT)
- …and monitoring compliance practices. This incumbent is responsible for conducting medical necessity audits by reviewing clinical practice standards and ... In addition to the clinical expertise needed for the medical necessity reviews, the incumbent will perform...a related field, or the equivalent + Knowledge of medical auditing, Federal healthcare program policies and… more
- Molina Healthcare (Detroit, MI)
- …training, and supervision of the use of the criteria for medical necessity . + Participates in and maintains the integrity of the appeals process, ... + Provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to members, targeting improvements… more
- Molina Healthcare (Long Beach, CA)
- …training, and supervision of the use of the criteria for medical necessity . + Participates in and maintains the integrity of the appeals process, ... + Provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to members, targeting improvements… more
- Highmark Health (Charleston, WV)
- …A key component of this role is to review denials of care based on medical necessity . The incumbent acts as a liaison for Highmark Wholecare with ... to provide clinical consultation and support with regard to program development, compliance with accepted medical standards,...Wholecare's core values, Code of Business Conduct and the Integrity Process + Foster a reprisal free environment to… more
- Serco (Washington, DC)
- …reimbursement rules + Extensive experience in making clinical determinations as to the medical necessity and appropriateness of services rendered and billed and ... (CHIP) improper payment estimates as required by the Payment Integrity Information Act of 2019 (PIIA). As part of...clinical guidance and technical assistance, ensuring adherence to the medical review function of the PERM Program .… more
- RTX Corporation (East Hartford, CT)
- …our employees to be their whole - best - selves at work because trust, respect, and integrity , are a part of our DNA. At Pratt & Whitney, the difference you make is ... look up. Are you ready to go beyond? Position Overview: Pratt & Whitney's Program Planning & Scheduling (PP&S) organization is searching for a Program Planner.… more
- RTX Corporation (East Hartford, CT)
- …our employees to be their whole - best - selves at work because trust, respect, and integrity , are a part of our DNA. At Pratt & Whitney, the difference you make is ... individual to join its Fighter Mobility team as a Program Analyst on the F119 SPaRE Program .... Contract Data Requirement Lists (CDRLs). + Promote data integrity by properly controlling and monitoring EV systems (wInsight,… more
- RTX Corporation (Windsor Locks, CT)
- …virtual doctor visits . Bright Horizons, child and elder care services . Teladoc Medical Experts, second opinion program . And more! At Collins, the paths ... Aerospace Power and Controls is seeking a dynamic Deputy Program Chief Engineer to lead the coordination of Engine...the industry. Their ideas drive our performance, and their integrity keeps our customers happy. Join us as we… more
- RTX Corporation (Rockford, IL)
- …virtual doctor visits + Bright Horizons, child and elder care services + Teladoc Medical Experts, second opinion program + And more! At Collins, the paths ... Power Systems business in Rockford is looking for a Program Quality Engineer to support the face of Quality...the industry. Their ideas drive our performance, and their integrity keeps our customers happy. Join us as we… more
- RTX Corporation (Haltom City, TX)
- …TX, 76137 USA Position Role Type: Onsite Collins Aerospace is looking for a Program Quality Engineer who will act as the Quality interface including customer and ... supporting DCMA activities both internally and externally at suppliers + Support/Participate in Program Reviews, including but not limited to: PDR, CDR PDPR, MPR +… more
