- Spectrum Billing Solutions (Skokie, IL)
- …Responsibilities: + Review patient admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain ... manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA...and skilled individuals. + Growth opportunities + Benefits - Medical , Dental, Vision + Flexible Paid Time Off +… more
- University of Southern California (Los Angeles, CA)
- …study participants through interviews, administration of tests or surveys or questionnaires, medical records review , or other collection procedures. + Assists ... described in protocol. Serves as contact for subjects, study personnel, Institutional Review Board (IRB) and study sponsor. + Assists in participant recruitment for… more
- Johns Hopkins University (Middle River, MD)
- …billing accuracy through encounter verification ie, clinic schedules, encounter forms, I/P consults, medical records. + Review and resolve Epic Charge Review ... Clinical Practice Association, Office of Billing Quality Assurance to include review of documentation. Serves as departmental expert on coding questions. Exercises… more
- Sharp HealthCare (La Mesa, CA)
- …from provider and communicates this to the care team.Refer defined cases for medical secondary review and share findings with providers.Provide advice to Revenue ... requires the ability to combine clinical/quality considerations with regulatory/financial/utilization review demands to assure patients are receiving care in the… more
- Molina Healthcare (Akron, OH)
- …as well as minimum over read standards. **Job Duties** + Coordinates the HEDIS medical record review which includes ongoing review of records submitted ... by providers and the annual HEDIS medical record review . + Participates in meetings with vendors for the medical record collection process. + As needed, may… more
- HCA Healthcare (Port Charlotte, FL)
- …your career path, we encourage you to apply for our Charge Nurse CNC Medical Oncology opening. We review all applications. Qualified candidates will be contacted ... **Description** **Introduction** Do you have the career opportunities as a Charge Nurse CNC Medical Oncology you want in your current role? We invest in what matters… more
- Sharp HealthCare (San Diego, CA)
- …Collaborate with clinical team to communicate changes in pre-authorization, denial, medical review , appeals, managed care contracts, and referrals to ... of financial planning for their transplant surgery, VAD implant, and future medical needs as well as assuring transplant department billing compliance. The primary… more
- Elevance Health (Cerritos, CA)
- …and medical records to either approve or summarize and route to nursing and/or medical staff for review . + The grievance and appeal work is subject to ... to convey the determination. + Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of… more
- MD Anderson Cancer Center (Houston, TX)
- …and identify possible avenues of appeal. * Contact third-party payers, insurance medical directors, case management, and utilization review to request ... EOBs, and appeal timelines. * Maintain understanding of insurance guidelines for medical necessity review , including M&R and InterQual, and working knowledge… more
- CVS Health (Phoenix, AZ)
- …the greater Phoenix area. Expectations/Responsibilities: + Reviews and prepares cases for medical necessity review of Applied Behavior Analysis (ABA). + Provide ... focus on utilization, quality and fraud waste and abuse review for individual cases for members across Aetna ....input into medical management programs/policies that pertain to neurodevelopmental disorders. +… more