- Excellus BlueCross BlueShield (Rochester, NY)
- …case planning and research, conducting onsite or desk audits, clinical reviews of medical records to ensure correct billing of services and appropriateness of care, ... Level I + Functions as a clinical reviewer of medical records, researching and investigating complex medical ...and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. +… more
- Community Health Systems (Las Cruces, NM)
- …and manage complex situations with discretion. **Licenses and Certifications** 1. **Preferred:** 2. RN - Registered Nurse - State Licensure and/or Compact ... incident reporting, and corrective actions to mitigate risk. + Manages claims and litigation processes, coordinating with legal counsel and maintaining detailed… more
- PeaceHealth (Vancouver, WA)
- … review and management of unexpected outcomes, serious patient events and medical errors. Facilitates and/or co-facilitates the review and investigation of ... clinical risk management risk investigations and response to events, potential claims , and grievances presented against caregivers, physicians and the organization… more
- Trinity Health (Livonia, MI)
- …and trouble shooting + Makes a manual requisition for patient orders for Registered Nurse approval during emergencies, codes and downtime. + Maintains unit ... function. + May be responsible for assuring that patient medical claim data used for billing purposes...access, retrieve and print reports from Quest/Vista. + Obtain, review and correct errors per error report(s) or upon… more
- Alameda Health System (Oakland, CA)
- …nursing background. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. Preferred ... Their responsibilities span from managing admissions to ensuring clean claims , identifying trends, and optimizing resource utilization. This role supports… more
- HCA Healthcare (Atlantis, FL)
- …patient safety and promoting quality care. **What qualifications you will need:** + Registered Nurse or other allied health professional + Bachelors Degree in ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...and patient safety program on a day-to-day basis and claims management program and risk management education for the… more
- Nestle (Schaumburg, IL)
- …related training, as needed. **POSITION REQUIREMENTS:** + Graduate of an accredited school of nursing, Registered Nurse in the State of Illinois + Minimum of 2 - ... other health care agencies and third party administrators for worker's compensation claims + Maintain confidential medical records to include pre-employment … more
- State of Georgia (Fulton County, GA)
- …additional experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT codes ... Nurse Investigator Georgia - Fulton - Atlanta (https://ga.referrals.selectminds.com/jobs/64040/other-jobs-matching/location-only)...clinical experience AND one (1) year experience working with medical claims . Preference will be given to… more
- Colorado State University (Fort Collins, CO)
- …getting authorizations/pre-authorizations + Experience as a Medical Assistant, Licensed Practical Nurse , Registered Nurse , or other relevant medical ... can thrive, grow, and make a lasting impact. + Review our detailed benefits information here. (https://hr.colostate.edu/wp-content/uploads/sites/25/2021/01/benefits-summary-afap.pdf) + Explore… more
- Independent Health (Buffalo, NY)
- …statistics. + Perform validation of diagnosis and procedure coding by reviewing medical record documentation and/or provider claims data. Ensure coding ... policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with Medical Director, response to… more