- Premera Blue Cross (Mountlake Terrace, WA)
- … medical policy changes, and coding changes. + Research and interpret medical claims utilization and program participation. Present findings to internal ... Coding Administrator_** will focus on identifying and coordinating appropriate codes to support claim system edits that direct payment of medical services. This… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …Performing comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review , special review requests, and UM ... clinical judgement, and contractual eligibility\. + Various immunizations and/or associated medical tests may be required for this position\. **Job Qualifications**… more
- Morley (Lansing, MI)
- …on large programs + Attend weekly meetings with the M&I Management Team to review schedule and needs **_Questions Before You Apply?_** Live chat with a Morley Talent ... work and in life. **_Health & Wellness Benefits_** + Medical and prescription coverage, including free annual physicals +...24/7 online access to doctors through Teladoc + 24/7 nurse help desk + Patient advocacy with free 24/7… more
- Morley (Saginaw, MI)
- …outbound documentation, communications, and various financial and record-keeping tasks + Review prepared packets for correct payment info and attach appropriate ... work and in life. **_Health & Wellness Benefits_** + Medical and prescription coverage, including free annual physicals +...24/7 online access to doctors through Teladoc + 24/7 nurse help desk + Patient advocacy with free 24/7… more
- Morley (Saginaw, MI)
- …+ Maintain files and process documents received via FedEx, mail and fax + Scan, review and secure checks + Audit all documents + Offer timely and accurate solutions ... work and in life. **_Health & Wellness Benefits_** + Medical and prescription coverage, including free annual physicals +...24/7 online access to doctors through Teladoc + 24/7 nurse help desk + Patient advocacy with free 24/7… more
- System One (Baltimore, MD)
- …benefit eligibility and support claims processing/adjudication. It includes pre- and post- claim medical review for Commercial, FEP, and Medicare ... Job Title: Clinical Medical Review Nurse Location:...corporate and medical policies. Essential Functions + Claims Review & Analysis (35%) Review… more
- Molina Healthcare (Rio Rancho, NM)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports ... DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities -...clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
- The County of Los Angeles (Los Angeles, CA)
- …REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse * or Medical Service Coordinator, CCS.** -OR- OPTION ... UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333)...needed, and to make recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review… more
- Travelers Insurance Company (Overland Park, KS)
- …Utilize evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims . Provides quality claim handling throughout the claim… more
- Travelers Insurance Company (Diamond Bar, CA)
- …Utilizes evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... negotiating and resolving assigned General Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim … more
