- CVS Health (Boise, ID)
- …each and every day. **Position Summary** The Quality Specialist will audit pre and post payment claims for accuracy and eligibility transactions. They ... identifying errors, necessary corrective measures, and may participate in special audit assignments. **Required Qualifications** + 1+ years of experience working in… more
- Molina Healthcare (Idaho Falls, ID)
- …programs. **Preferred Qualifications** * Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified ... Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring timely claims...audit , provider disputes, appeals, and 1500 & UB04 claim experience are highly preferred. Ability to apply state… more
- Sedgwick (Boise, ID)
- …; ensures appropriate recommendations are made on claims . + Consistently achieves appropriate quality audit scores. + Acts as clinical resource to claims ... of claims including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Acts as a backup for… more