- City of New York (New York, NY)
- …submission and, issuing verification letters to claimants and medical providers; 2) Review and disallow claims for improper service or for exceeding the ... threshold under New York State No Fault Law; 3) Review all new claims for data accuracy...New York State Department of Financial Services correspondence; 10) Review medical providers and law firms to… more
- Robert Half Accountemps (Spokane, WA)
- …of claims while adhering to industry standards and regulations. Responsibilities: * Review and process medical claims with accuracy and attention to ... Washington. This is a long-term contract position that requires expertise in medical claims , billing, and insurance processes. The ideal candidate will play a… more
- Molina Healthcare (Green Bay, WI)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
- TEKsystems (West Lake Hills, TX)
- …clinical experts, data scientists, and legal consultants to shape the future of medical claims review and healthcare resource optimization. Job ... * Develop economic models to assess the impact of medical interventions and policy changes. * Conduct cost-benefit and...* Collaborate on the design of predictive tools for claims review and risk stratification. * Prepare… more
- Takeda Pharmaceuticals (Lexington, MA)
- …and review and approval of clinical data on file to support promotional claims . + Leads the Medical Review process, procedures, and documentation of ... Team(s) to lead a high performing team responsible for medical information and medical review ...documents and enforcement action letters as applicable to promotional claims and shares implications with Medical Reviewers… more
- Lincoln County (Newport, OR)
- …who is reliable with a strong attention to detail. The person in this role will review medical claims , prior and subsequent to billing, to ensure accuracy ... Programs (EAP) Essential Functions/Major Responsibilities Billing and Coding: + Review charges prior to initial claims submission...Make corrections as needed, whether minor or major. + Review outpatient medical and mental health claim… more
- Deloitte (Philadelphia, PA)
- … Workstream Manager leads teams responsible for the review of Non-Emergent Medical Transportation (NEMT) claims for a State Medicaid program with the primary ... knowledge, familiarity with healthcare policy and approval processes + Experience managing claims review teams + Expertise in identifying Fraud, Waste, and… more
- Emanate Health (Covina, CA)
- …decisions using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete ... #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying… more
- Providence (WA)
- …we must empower them.** **Providence is calling a Sr. Professional Liability Medical Claims Manager who will:** **Investigate, evaluate, and manage professional, ... Program:** + Communicate with patients, claimants, caregivers, providers, leadership + Review and analyze medical records, interview witnesses, assist with… more
- Central Maine Medical Center (Lewiston, ME)
- …leave program for Parental Leaves + Comprehensive Wellness Program + Essential Duties: Review claims using electronic claims software -compliance products, ... our community and for each other every day. Central Maine Healthcare is seeking a Claims Processing Rep to join our Team. This is a full time 40-hour, benefits… more