- St. George Tanaq Corporation (Jackson, MS)
- …Requirements **Required Experience and Skills** + One (1) year of Medicare appeals, medical review , clinical, healthcare regulatory interpretation/application, ... Dispute Resolution Reviewer I Fully Remote*GA Job Type Full-time Description...university in healthcare or related discipline Additional experience in Medicare appeals, medical review , clinical, or other… more
- AdventHealth (Altamonte Springs, FL)
- …collaboration with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality physician ... complexity of care of the patient. The Second Level Reviewer I educates members of the patient care team...(ROM), and quality. . Completes accurate and timely record review to ensure the integrity of documentation compliance. .… more
- St. George Tanaq Corporation (Phoenix, AZ)
- …Experience and Skills** + Must have 2-3 years of medical dispute resolution or Medicare appeals, medical review , clinical, or related experience in a healthcare ... Dispute Resolution Reviewer III Fully Remote*GA Job Type Full-time Description...and impartial and supports the determination made, and documents review + Makes sound, independent decisions based on medical… more
- Centers Plan for Healthy Living (Margate, FL)
- …for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help identify and manage ... their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- The Joint Commission (Oakbrook Terrace, IL)
- …Field Representatives, with minimal direction or supervision, survey and/or review health care organizations throughout the United States. Field Representatives ... **Responsibilities** Position Accountabilities: + Ability to analyze and synthesize survey/ review findings to provide conclusions, recommendations and educational opportunities.… more
- SSM Health (MO)
- …risk adjustment (mortality) findings. + Maintains knowledge of Centers for Medicare and Medicaid Services (CMS) requirements related to clinical documentation and ... to clinical staff regarding these requirements during the concurrent record review process. + Maintains knowledge of mortality models, observed rate/expected rate… more
- Insight Global (San Diego, CA)
- …levels expected by MedImpact's internal and external customers and the Centers for Medicare and Medicaid Services (CMS). This group of people will be trained to ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills… more
- R1 RCM (Chicago, IL)
- …billing, resolution, and revenue cycle management. **Key Responsibilities:** + Review outpatient hospital facility, clinic, and physician documentation, including, ... research and validate hospital reporting. + Build and maintain expertise in Medicare and Managed Care billing, coding, and reimbursement policies. + Support… more
- The Cigna Group (Bloomfield, CT)
- …for Medicare Part D Health Plans: PDP, MAPD, and Special Needs Program (SNPs) + Review Medicare Part D Plan bid assumptions for Regulated Medicare Part D ... Health Plans + Create analytics for Medicare Part D Bids substantiation for Desk Review and Medicare Part D audits + Utilize independent judgement and… more
- Robert Half Finance & Accounting (Eatontown, NJ)
- …Eatontown and offers a hybrid schedule, has an opportunity for a Director Medicare /Medicaid Reimbursement. + The Director will have advanced level of knowledge of ... above. + Planning, preparing and reviewing of the annual Medicare /Medicaid cost reports filings. In partnership with the Vice... federal regulations. + Responsible for the completion and review of the annual New Jersey Acute Care Hospital… more