Claim Reviewer jobs

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Quality Assurance IME and Peer Medical Report Reviewer
Garden City, NY 11530
Our clients have claims in every state across the country with client management contacts residing in New York, California, Illinois, Michigan, Florida,...
Desired Experience: Time Management, Microsoft Office, Medical Terminology, Managed Care
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Clinical Review Nurse
Mechanicsburg, PA 17050
$52,800 - $79,200 a year
Experience using claims processing system (e.g., MCS/FISS), etc. *. Review and analyze pre and post pay complex health care claims from a medical perspective:....
Desired Experience: RN, ICD-10, Medical Coding Certification, Microsoft Office, CPT Coding, ICD-9
Utilization Management Specialist
Charlestown, MA 02129 (Fenway-Kenmore area)
Enters authorizations into CCA’s data system to ensure timely review of and downstream claims processing. Communicates results of reviews in the centralized...
Desired Experience: RN, Medical Coding, Managed Care

PAS Closeout Reviewer

Eugene, OR 97401 (Cal Young area)
Review claim comments and issues posted to ensure it is appropriate to release the requested payment. Alacrity Services is a wholly owned subsidiary of Lowe’s...
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RN Reviewer, PDIP

We are currently seeking a dynamic RN REVIEWER, PDIP to join our team at our office in WOBURN, MA. The PSYCHOTROPIC DRUG INTERVENTION PROGRAM (PDIP) is a unique...
Desired Experience: EMR Systems, RN, Behavioral Health, Microsoft Office, Managed Care

Medicare Advantage Documentation Reviewer

Medford, MA
Document and report to payor claims. The Reviewer will work closely with PCP Office staff and with the PCP Billing staff to coordinate pre and post visit...

Process QA Reviewer, Medical Claims

Arlington, TX 76011 (East area)
Knowledge of claim payment and process preferred. We have almost 900,000 healthcare providers under contract, an estimated 68 million consumers accessing our...
Desired Experience: Microsoft Office

Utilization Management Representative I-III - Midland, GA- P...

Refers cases requiring clinical review to a Nurse reviewer. Managing incoming calls or incoming post services claims work....

Clinical Reviewer

Plano, TX
Works patient facing holds to resolve and get claims out the door. ESSENTIAL DUTIES AND RESPONSIBILITIES:....
Desired Experience: Medical Office Experience, ICD-10, CPT Coding, Excel

Clinical Appeals Reviewer (LHI)

La Crosse, WI 54602
Process daily / weekly claims error files to ensure efficient and expeditious handling of claims. Also includes, the maintenance of the pended claims file and...
Desired Experience: ICD-10, CPT Coding, Microsoft Office, ICD-9, Military Experience

Physician Reviewer - Rheumatology - Remote

National Medical Reviews Inc
Atlanta, GA
Under the direction of the Chief Medical Director, provides peer reviews services, which may include benefit coverage opinions, case reviews, claims auditing,...
Desired Experience: Patient Care
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Construction Scheduler Analyst/Reviewer

Whitman, Requardt and Associates, LLP
Virginia +1 location
Develops strategies for negotiating claims. Provides technical support in claims litigation. Construction Scheduler - We are seeking qualified construction...
Desired Experience: Primavera, Microsoft Powerpoint, Project Management, Oracle, Microsoft Office, Construction Experience, Construction Management, Primavera P6

AvMed Clinical Reviewer

Miami, FL
Conducts prospective reviews and reconciliation for targeted claims. Review medical records to determine if specific diagnoses were omitted from claims...
Desired Experience: RN, RHIT, ICD-9, RHIA, Medical Coding Certification, Managed Care
Project Cost Specialist I
Flatwater Inc. a subsidiary of Ho-Chunk, Inc.
Bellevue, NE
Reviewer of contracts accounts payable including subcontractors and vendors invoices. Interface with internal departments (HCSS Accounting/Program & Project...
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Licensed Utilization Review II, RN Preferred (PS10997)
Virginia Beach, VA 23464
May access and consult with peer clinical reviewers, Medical Directors and/or delegated clinical reviewers to help ensure medically appropriate, quality, cost...
Desired Experience: RN, Managed Care
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