Medical Claim Review Nurse

Job DescriptionJOB DESCRIPTIONJob SummaryUtilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding...

Job DescriptionJOB DESCRIPTIONJob SummaryUtilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding...

Job DescriptionHealthComp is seeking an experienced Claims Advocate to review documentation and support members through written and verbal communication to determine benefits due and resolve medical claims.Key ResponsibilitiesReview documentation, determine benefit due, and complete the denial or payment process to resolve medical claims.Request information...

IntroductionAt Risk Placement Services, we're more than just a team – we thrive on collaboration, creativity, and tackling challenges head-on. Our culture fosters an environment where every idea counts, and every individual's contribution matters. Step into a world of excitement and innovation as we work with top-rated carriers to design robust coverage...

Join Our Team: Network Adjusters, Inc. is in search of a seasoned insurance claims expert to become a vital part of our leadership team.Role Overview: As an Insurance Claims Team Leader, you will be instrumental in our claims division, managing the complete claims lifecycle in a dynamic setting to ensure adherence to all compliance and service standards. You...

About the RoleRisk Placement Services (RPS) is seeking a skilled Claims Investigator to join our team. As a Claims Investigator, you will play a critical role in investigating and evaluating potentially fraudulent claims to determine if a legitimate claim exists.Key ResponsibilitiesInvestigate and evaluate claims to determine legitimacyConduct moderately...

Job DescriptionJob DescriptionDescriptionHealthComp is looking for an experienced Claims Advocate to review documentation, and support members through written and verbal communication to determine benefits due and resolve medical claims. This is a great opportunity for someone with call center experience with strong attention to detail and customer focused...

About the JobPremier Medical Staffing Services, LLC is seeking an experienced Medical Surgical Registered Nurse for a challenging Travel Nursing assignment in a dynamic healthcare environment.Job SummaryWe are looking for a skilled and compassionate Medical Surgical Registered Nurse to join our team on a travel assignment. As a Medical Surgical Registered...

Premier Medical Staffing Services, LLC is seeking an experienced Medical Surgical Registered Nurse for an exciting Travel Nursing job in Covington, GA. Shift: 3x12 hr nights Start Date: 09/16/2024 Duration: 12 weeks Pay: $1521 / WeekPremier is searching for a Healthcare Ambassador like you!At Premier Medical Staffing Services, we are guided by our core...

JOB DESCRIPTION Job Summary Analyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge....

About Matrix Medical NetworkMatrix Medical Network is a leading provider of clinical services and expertise that empower primary care providers and at-risk health plan members to better manage their health at home.Job SummaryWe are seeking a skilled Nurse Practitioner to join our team as a PRN/Part Time Clinical Health Specialist. In this role, you will...

About Matrix Medical NetworkMatrix Medical Network is a leading provider of clinical services and expertise that empower primary care providers and at-risk health plan members to better manage their health at home.Job SummaryWe are seeking a skilled Nurse Practitioner to join our team as a PRN/Part Time Home Risk Assessment Specialist. In this role, you will...

Effectively communicates with the Contractor regarding all schedule/progress & project controls related matters and concerns in the weekly status meetings and all other schedule related meetings. Reviews Contractor’s Baseline schedule submissions and verifies that all work scope is identified properly and logically sequenced correctly; provides written...

Effectively communicates with the Contractor regarding all schedule/progress & project controls related matters and concerns in the weekly status meetings and all other schedule related meetings. Reviews Contractor’s Baseline schedule submissions and verifies that all work scope is identified properly and logically sequenced correctly; provides written...

Job OverviewPosition SummaryThe Senior Investigator role within the Special Investigations Unit (SIU) is crucial for overseeing daily operations and strategic initiatives aimed at combating fraud, waste, and abuse (FWA) in healthcare.Key Responsibilities• Address all reported instances of potential FWA, conducting thorough investigations into fraudulent,...

Job DescriptionThe Jonus Group is seeking a skilled and dedicated Commercial Insurance Account Manager to join our team.Key Responsibilities:Build strong relationships with clients by understanding their business needs and providing personalized insurance solutions.Regularly communicate with clients to assess their evolving insurance requirements and address...

Job Description Our client is seeking a P&C licensed, dedicated, and proactive Commercial Lines Account Manager to join their team. Benefits Competitive salary: $50-60K Comprehensive benefits package Professional development opportunities and training. Supportive and inclusive work environment. Qualifications Active P&C license Strong...

Company Overview:At St. Tammany Health System, our mission is to provide exceptional healthcare services within our community. We pride ourselves on our commitment to hiring and retaining top-tier professionals across all roles within our organization.Located in a serene and picturesque area, our health system offers a competitive compensation package that...

Job Summary:Responsible for all medical services performed by the treatment center. Provides medical oversight and leadership to the varying clinical staff under their supervision to ensure the quality of care is provided to our patients. Essential Functions: Provides and/or ensures, via physician extenders, a physical examination of all patients upon...

Premier Medical Staffing is seeking a travel nurse RN Rehabilitation for a travel nursing job in Covington, Georgia. Job Description & Requirements Specialty: Rehabilitation Discipline: RN Start Date: 09/03/2024 Duration: 13 weeks 36 hours per week Shift: 12 hours, nights Employment Type: Travel Looking for a great Travel Rehabilitation Job in Covington,...