- Centene Corporation (Helena, MT)
- …on workplace flexibility. **Position Purpose:** Perform clinical/coding medical claim review to ensure compliance with coding practices through a comprehensive ... review and analysis of medical claims, medical records, claims...directives, precedent, AMA and CMS code edit criterion + Review medical records to ensure billing is consistent with… more
- US Tech Solutions (Columbia, SC)
- …using indicated protocol sets or clinical guidelines. + Provides support and review of medical claims and utilization practices.. **Responsibilities:** + May provide ... any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a reasonable charge payment… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member ... and treatment of members' behavioral health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as… more
- NANA Regional Corporation (Oak Ridge, TN)
- …professionals, apply today! **Responsibilities** + Development, revision, and peer review of Nuclear Criticality Safety (NCS) documentation such as Criticality ... Daily nuclear facility support as needed, consisting of facility walkdowns, review of NCS requirements implementing documents, participation at facility Operational… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member ... and treatment of members' medical health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as well… more
- Centene Corporation (Atlanta, GA)
- …a fresh perspective on workplace flexibility. **Position Purpose:** Authorize and review utilization of dental services provided in provider offices, community ... a resource between the health plan, provider relations, and dental providers + Review treatment plans and initial evaluations + Comply with performance measures in… more
- CVS Health (Franklin, TN)
- …each and every day. **Position Summary** Performs claim documentation review , verifies policy coverage, assesses policy application validity, communicates with ... and beneficiaries to ensure accurate and timely handling of the medical review process. Contributes to the efficient and accurate handling of medical and… more
- Atlantic Health System (NJ)
- 1. Provides timely review of SOC, ROC and Recertification documentation. Utilizes CRC assessment tool to provide clinical feedback related to OASIS accuracy and POC. ... and secondary reasons for home care through thorough chart review . Reviews and advances 485 in a timely manner....10. Attends continuing education to develop proficiency in OASIS review and ICD-10 coding. Required: + Current NJ RN… more
- TEKsystems (Houston, TX)
- …skills to support compliance and operational excellence. Key Responsibilities + Review and analyze borrower organizational charts to confirm ownership structures, ... or red flags in organizational hierarchies and escalate for further review . + Review legal formation documents for LLCs, partnerships, corporations, and trusts… more
- M&T Bank (Buffalo, NY)
- **Overview:** Completes entry-level review of documents from Institutional clients and reports on identified exceptions. **Primary Responsibilities:** + Complete ... Custody tracking system to original documents. The data for review is uploaded to the tracking system for reporting...and update the tracking system accordingly. + Follow basic review criteria according to established procedures. + Update the… more