Medical Claims Review Nurse

Position OverviewAre you dedicated to enhancing healthcare outcomes? KARNA LLC is seeking a skilled Medical Claims Review Nurse to contribute to our mission of supporting individuals affected by significant health events. This role is pivotal in ensuring that claims are meticulously reviewed for medical necessity and in addressing provider appeals...

Key Responsibilities:In this role, you will operate under general oversight to assess proposed stipulated settlement agreements related to workers' compensation claims. Your primary focus will be to ensure adherence to relevant laws, regulations, and agency protocols.Additionally, you will provide informed recommendations to the appropriate parties,...

Key Responsibilities:In this role, you will operate under general oversight to assess proposed stipulated settlement agreements related to workers' compensation claims. Your primary focus will be to ensure that all agreements adhere to relevant laws, regulations, and agency protocols.Additionally, you will:Provide informed recommendations to enhance the...

Position Overview:In this role, you will operate under general oversight to assess proposed stipulated settlement agreements related to workers' compensation claims. Your primary responsibility will be to ensure that all agreements adhere to relevant laws, regulations, and agency protocols.Key Responsibilities:Conduct thorough reviews of stipulated...

Job Title: HEDIS Nurse Abstractor SpecialistJob Summary:Spectraforce Technologies is seeking a highly skilled HEDIS Nurse Abstractor Specialist to join our team. As a HEDIS Nurse Abstractor Specialist, you will be responsible for reviewing medical records, abstracting pertinent data, and entering it into a specified database to support HEDIS reporting.Key...

Job Summary:Piedmont is seeking a highly skilled Clinical Appeals Specialist to join our team. As a Clinical Appeals Specialist, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key Responsibilities:Conduct detailed reviews of patient medical...

About the Role:Piedmont Healthcare Corporate is seeking a skilled Clinical Appeals Specialist to join our team. As a key member of our appeals process, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key Responsibilities:Conduct detailed...

Job SummaryAs a Nurse Investigator with the Georgia Department of Law, you will play a critical role in uncovering and preventing healthcare fraud within the Medicaid program. Under the direction of the Fraud Unit Director, you will assist in conducting thorough investigations by reviewing provider and recipient records, making determinations of medical...

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring...

Imagine a workplace that encourages you to interpret, innovate and inspireOur employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive changeYou can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring...

Imagine a workplace that encourages you to interpret, innovate and inspireOur employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive changeYou can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring...

Job SummaryWe are seeking a highly skilled Specialty Billing Technician to join our team at Walgreens. As a key member of our revenue cycle team, you will be responsible for processing and managing medical claims, ensuring accurate and timely payment.Key Responsibilities:Process and manage medical claims, including reviewing and verifying patient...

Position OverviewThe Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments. Conduct review of facility and outpatient bills as it compares with medical records...

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring...

Position OverviewThe Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments. Conduct review of facility and outpatient bills as it compares with medical records...

Position Overview:The Medical Liability Claims Specialist plays a crucial role in managing and resolving claims related to medical malpractice. This position requires a deep understanding of the complexities involved in liability claims and the ability to navigate the intricacies of medical malpractice insurance.Key Responsibilities:Utilize a Bachelor’s...

Clinical Review Nurse I - Medicare Part ANational Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.Location:This is a virtual position and preferred candidates reside within 50 miles...

Terms of Employment Contract-to-Hire, 12 months This position is fully remote. Candidates must be based in Maryland, Washington, DC, Virginia, West Virginia, Pennsylvania, Delaware, New Jersey, New York, North Carolina, Florida, or Texas. This is a full-time position, 40 hours per week. Overview Our client is seeking five (5) Claims...

Terms of Employment Contract-to-Hire, 12 months This position is fully remote. Candidates must be based in Maryland, Washington, DC, Virginia, West Virginia, Pennsylvania, Delaware, New Jersey, New York, North Carolina, Florida, or Texas. This is a full-time position, 40 hours per week. Overview Our client is seeking five (5)...

Position OverviewThe Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments. Conduct review of facility and outpatient bills as it compares with medical records...