- Elevance Health (Waukesha, WI)
- ** Clinical Documentation and Claims Integrity Director** **Location:** Alternate locations may be considered. This position will work a hybrid model (remote and ... quality of life through home-care and community based services. The ** Clinical Document Improvement Director** is responsible for leading encounter processing,… more
- Humana (Springfield, IL)
- …any trended claims issues stemming from internal systems issues to Provider Claims Manager and support development of systems issue resolution + Assist with ... Humana Fully Integrated Dually Eligible (HMO D-SNP) in IL, is seeking a Claims Research & Resolution Professional claims educator, who will be responsible… more
- BJs Wholesale Club (Marlborough, MA)
- …counsel and TPA. + Identifies claim trends and provides recommendations to the Claims Manager and Director, Risk Management, and Insurance for decreasing the ... and any required OSHA reporting. + Participates in a review of the performance of TPA's with respect to...TPA's with respect to file reviews, best practice audits, clinical consultation, service providers and claims action… more
- Molina Healthcare (Des Moines, IA)
- …Claim Experience. **Required Experience** * 7 years' experience in healthcare claims review and/or Provider appeals and grievance processing/resolution, ... Provider disputes and appeals to ensure adherence with Molina claims processing standards and provider contractual agreements. Includes responsibility from… more
- Children's Mercy Kansas City (Kansas City, MO)
- …can improve the lives of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, ... from admission through hospital stay to discharge. Adeptly uses evidence based clinical practice guidelines to determine the appropriate level of care and the… more
- St. Luke's University Health Network (Allentown, PA)
- …is a Certified Medical Coder who ensures clean claim submission and timely review and resolution of coding related claim denials for professional services, FQHC, ... tools and Insurance carrier medical and reimbursement policies during the claim review process. JOB DUTIES AND RESPONSIBILITIES: + Maintain current knowledge of… more
- Elevance Health (Atlanta, GA)
- ** Clinical Content Strategy Manager ** **Location:** Norfolk, VA; Atlanta, GA (preferred). This role requires associates to be in-office 1 - 2 days per week, ... not eligible for current or future visa sponsorship._ The ** Clinical Content Strategy Manager ** will be responsible...take edits from concept to specification and then through review , testing and finally data validation. Your goal is… more
- Molina Healthcare (Sioux City, IA)
- …proactively identifying, validating, and tracking cost containment initiatives through comprehensive clinical and financial analysis of claims data, medical ... execute effective Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as well as… more
- Moses/Weitzman Health System (Middletown, CT)
- …Center located at 19 Grand Street in Middletown, CT. **NATURE OF POSITION:** The Clinical Risk Manager leads and oversees clinical risk management efforts ... at CHC and works collaboratively with the MWHS Legal Department, CHC senior clinical leaders, practice administration, and support staff to carry out the General… more
- Prime Therapeutics (Oklahoma City, OK)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Clinical Account Manager - Georgia PDL - Remote in Georgia **Job Description** ... + Provides clinical operations input and support of client specific claims processing programs, coordinates implementations of clinical projects and programs… more