- PedIM Healthcare (Crystal River, FL)
- …professional development and training. Supportive and collaborative work environment. Responsibilities: Review and process medical claims for accuracy ... Florida. We are currently seeking a detail-oriented and experienced Medical Billing Specialist to join our team. If you're...data and resolve any discrepancies. Generate and submit insurance claims to payers promptly. Follow up on unpaid or… more
- StarKist Co. (Reston, VA)
- …back-up documentation from brokers, customers and/or carriers to validate claims . Resolves invalid or unauthorized deductions by following deductions procedures ... Maintain deduction tracking of all open and closed claim for assigned accounts. Monitor Accounts Receivable daily, identify and collect on past due balances, resolve… more
- Baggett Law (Jacksonville, FL)
- …with clients regularly to provide updates, set expectations, and gather information Review and analyze medical records, police reports, insurance policies, and ... Performance-Based Bonus Responsibilities: Evaluate and investigate new personal injury claims for merit and liability Manage a high-volume caseload...other case documents Coordinate medical treatment for clients and monitor progress Draft and… more
- Unknown (Philadelphia, PA)
- …and plan modeling bill edits credentialing risk management health plan replacement medical networks care management & navigation utilization review disease ... Held Founded 2004 Employees 501-1000 Categories Insurance Specialties bill review out-of-network repricing primary ppo and alternative repricing administration edi… more
- Unknown (San Francisco, CA)
- … of health pharmacy and workers compensation claims . state and federal level external review nurse review and precert medical director review About ... the Role The Company is seeking a VP of Sales for Strategic Accounts to join their team. The successful candidate will be responsible for driving sales growth, with a focus on long-term planning and execution, and building strong relationships with various… more
- The Computer Merchant, LTD. (Blacklick, OH)
- …PMBOK and best practices. * Healthcare/IT Experience: Experience supporting healthcare claims , financial processing, or pharmacy benefits manager projects for state ... * Advanced Planning: Project management skills to keep deliverables on track during review cycles. Education & Certifications * Bachelor's degree in a relevant field… more
- CVS Health (Franklin, TN)
- …policyholders and beneficiaries to ensure accurate and timely handling of the medical review process. Contributes to the efficient and accurate handling ... with heart, each and every day. **Position Summary** Performs claim documentation review , verifies policy coverage, assesses.... Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of… more
- APTIM (Santa Fe, NM)
- **Summary:** The Senior-Level Claims Reviewer is responsible for independently reviewing, analyzing, and processing complex claims related to disaster losses ... and program guidelines. This position serves as a technical authority on claims interpretation, policy compliance, and documentation quality. The Senior Reviewer … more
- APTIM (Santa Fe, NM)
- **Summary:** The Mid-Level Claims Reviewer supports the claims process by reviewing, evaluating, and documenting claims for disaster-related losses. This ... navigating documentation requirements, and contributes to a customer-focused, efficient claims lifecycle. Mid-level reviewers also identify when site inspections or… more
- City of New York (New York, NY)
- …the Corporation Counsel and other City agencies to investigate and resolve claims pre-litigation. The Claim Specialist II, Sidewalk/Roadway Liability Claims ... with applicable laws. BLA furthers this goal in its review , evaluation, and authorization of requests to settle litigated...and damages, and preparing an objective evaluation of the claim ; - Maintain a complete claims file… more
- Healthfirst (NY)
- **Duties//Responsibilities:** + **The Medical Peer Reviewer will assess// review requests for authorization, and claims payment, based on medical ... based on changing needs of the organization.** **Weekday Requirements:** + **The Medical reviewer requires 25 hours a week of coverage//5 days per week.** +… more
- Zelis (FL)
- …Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest ... plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records...concepts to expand the DRG product. + Manage assigned claims and claim report, adhering to client… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …as required, which may include audits designed to review the adequacy of medical record documentation to support claims as well as inquiries into suspected ... to the Director of Billing Compliance, the Senior Billing Compliance Reviewer ensures the integrity, accuracy, and regulatory compliance of Dana-Farber Cancer… more
- Chenega Corporation (Rockville, MD)
- …Professional Services Strategic Business Unit** company, is looking for a Physician- Contract Medical Reviewer (CMR) to support the Department of Health and ... to the clients Rockville, MD location. + Professional Background: Relevant experience in claims review , healthcare administration, or related fields. + A minimum… more
- Chenega Corporation (Rockville, MD)
- …Services Strategic Business Unit** company, is looking for a Nurse Practitioner-Contract Medical Reviewer (CMR) to support the Department of Health and ... compensation programs, or managed care. + Professional Background: Relevant experience in claims review , healthcare administration, or related fields. + A… more
- US Tech Solutions (Columbia, SC)
- …following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a reasonable charge ... protocol sets or clinical guidelines. + Provides support and review of medical claims and...families/caregivers. Reviews first level appeal and ensures utilization or claim review provides thorough documentation of each… more
- Evolent (Boston, MA)
- …+ Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review determinations and contacts ... mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are performed… more
- Centene Corporation (Helena, MT)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Perform clinical/coding medical claim review to ensure compliance with coding ... practices through a comprehensive review and analysis of medical claims , medical records, claims history, state regulations, contractual obligations,… more
- Elevance Health (Washington, DC)
- …unit goals to ensure customer satisfaction. **How you'll make a difference:** + Conducts medical review / claim review of beneficiary health records ... located at 609 H. Street NE.** The **Physical Therapist Reviewer ** is responsible for performing medical record...with regulations and requirements. + Codes and prices complex claims using ICD-9, HCPCS and CPT manuals and coding… more
- Adecco US, Inc. (Minneapolis, MN)
- …regulations, and clinical criteria, rendering approvals when appropriate. . You will summarize medical information for review by the Medical Director as ... days **Pay:** $40.50 to $42.50 an hour **Responsibilities of the RN Appeals Reviewer :** . Responsible for conducting thorough reviews of member and provider appeals,… more
