Healthcare - Medical Claim Review Nurse

Job Description Job Summary Thorough knowledge of processing professional, outpatient facility, and inpatient facility claims for Medicare, Medicaid, and Marketplace plans. Assists Molina departments with reviewing and conducting analysis of claims to ensure regulatory requirements are appropriately applied. Clearly documents claims research results and...

**JOB DESCRIPTION** **Job Summary** Responsible for reviewing Medicaid, Medicare, and Marketplace claims for overpayments; researching claim payment guidelines, billing guidelines, audit results, and federal regulations to determine overpayment accuracy and provider compliance. Interacts with health plans and vendors regarding recovery outstanding...

(Workers Compensation Claims Examiner I - Medical Claims) Intro Our client, the largest privately held third party claims administrator in the United States, is seeking a Workers Compensation Medical Claims Examiner I. We are looking for a professional with 2-5 years of experience in Texas Workers' Compensation Claims and a Texas Workers' Compensation...

Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired...

Job Description Job Summary Job Duties Uses analytical skills to conducts research and analysis for issues, requests, and inquiries of high priority claims projects Assists with reducing re-work by identifying and remediating claims processing issues Locate and interpret regulatory and contractual requirements Tailors existing reports or available data...

Job DescriptionJob Description The focus of this position will be research and root cause analysis of claims / config issues with direct provider interaction and collaboration with our provider relations team. Additionally, the role will help with overpayment recovery, claims payment and adjustment projects, and reviewing proposed SAI concepts from PI and...

Job DescriptionJob Description Job Summary Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings....

**JOB DESCRIPTION** **Job Summary** Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients...

Job DescriptionJob Description This position is located in Cypress, CA The Need: We are seeking a Claims Supervisor to join our growing team. In this role, you will be responsible for providing leadership and oversight to the Claims team. Accountable for ensuring the team adheres to standard work and meets department key performance indicators. ESSENTIAL...

Job DescriptionJob Description This position is located in Cypress, CA The Need: We are seeking a Claims Supervisor to join our growing team. In this role, you will be responsible for providing leadership and oversight to the Claims team. Accountable for ensuring the team adheres to standard work and meets department key performance indicators. ESSENTIAL...

Job DescriptionJOB DESCRIPTIONJob SummaryPerforms research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant...

Job DescriptionJOB DESCRIPTIONJob SummaryDesigns and implements processes and solutions associated with a wide variety of data sets used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables by applying statistical analysis techniques to examine structured and...

Job DescriptionJOB DESCRIPTIONJob Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients...

**Remote and must live in the United States** Job Summary Responsible for leading, organizing and directing the activities of the Provider Appeals Unit that is responsible for reviewing and resolving provider complaints and communicating resolution in accordance with the standards and requirements established by the Centers for Medicare and...

Job DescriptionJOB DESCRIPTIONJob Summary Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid KNOWLEDGE/SKILLS/ABILITIES Responsible for the...

Job Summary Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid KNOWLEDGE/SKILLS/ABILITIES Responsible for the comprehensive research and resolution...

Job Description***Remote and must live in the United States***JOB DESCRIPTIONJob Summary Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member and provider complaints and communicating resolution to members or authorized representatives in accordance with the...

Job DescriptionJOB DESCRIPTIONJob SummaryPerforms research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant...

TravelNurseSource is working with Summit Medical Staffing to find a qualified CVOR RN in Long Beach, California, 90806! Pay Information $2,340 to $2,520 per week About The Position Your journey in Travel Healthcare starts here! At Summit, our commitment goes beyond medical staffing expertise; it extends to a genuine and compassionate partnership that...

Job Description Job Description Facility Overview At Ocean View Psychiatric Health Facility, we are committed to serving as a community resource, providing the highest quality of mental health services. Currently, Ocean View operates as an adult 39-bed voluntary acute in-patient facility, offering private rooms and individualized care through a...