- Highmark Health (Little Rock, AR)
- … review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate level of payment and ... rejection and the proper action to complete the retrospective claim review with the goal of proper...in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or… 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
- Lowe's (Mooresville, NC)
- … Claim Decision Points - Reserving, Settlement, RTW, subrogation, Nurse Case management triggers, associate experience, litigation avoidance + Reviews and ... **Your Impact** The Sr Analyst-Workers Compensation Claims will provide insight and support to drive...for optimal or early resolution. + Works cross-functionally to review and revise litigation management guidelines, and Request for… more
- Beth Israel Lahey Health (Plymouth, MA)
- …Services and Medical Staff Officers with tracking/trending of adverse outcomes and medical malpractice claims in order to improve quality of care and advance ... for BID-P including all phases of actual and potential claims management. Identifies exposures to loss and analyzes the...safety and address other serious issues. + Collaborates with Nurse Directors, Managers, providers and other staff to keep… more
- Fairview Health Services (St. Paul, MN)
- …+ Collaborates with Clinical Denials Nurse Specialist and Leadership in high-dollar claim denial review and addresses the coding components of said claims ... reimbursement for services provided by the hospital/physician. Reviews and analyzes medical records and coding guidelines to formulate coding arguments for appeals… more
- Constructive Partnerships Unlimited (Brooklyn, NY)
- …in the management of medications. POSITION DUTIES 1. Maintain effective communication on medical issues with VP of Nursing, Nurse Administrator, Registered ... Nurse (RN), and Medical Coordinators2. Maintains medical records, including obtaining/filing all necessary reports and maintaining database of individuals… more
- The Hartford (Hartford, CT)
- …Benefits Manager and other key players (vocational rehabilitation consultants, medical nurse reviewers, etc.) for proactive movement of claim to resolution. ... threat protocol process when deemed clinically appropriate. Advises on highly complex claims at multidisciplinary clinical review roundtables to ensure optimal… more
- Access Dubuque (Dubuque, IA)
- …records. Review account and correct demographics and A/R. Research claim activity; handle manual insurance claim requests; handle carve-outs; follow-up ... Customer Service Representative ** Medical Associates** 1 Positions ID: ok7YyfwH Posted On...corrected HCFA's, protesting denials and follow-up to ensure the claim reaches end of process. + Responsible for handling… more
- Molina Healthcare (Orem, UT)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...for clinical member services review assessment processes. Responsible for verifying that services are… more
- Chenega Corporation (Rockville, MD)
- …to the clients Rockville, MD location. + Professional Background: Relevant experience in claims review , healthcare administration, or related fields. + A minimum ... program knowledge, leadership, and/or support experience. + Must have experience in claims review , healthcare administration, or related fields. + Must have… more