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Medical Claims Reviewer Jobs

Medical Claims Associate ( Remote)
By Others At United States
This is a fully remote position.
·Accurately code explanation of benefits
·1 – 2 years claims processing experience.
·A working knowledge of ICD10, CPT codes and HIPAA guidelines
Duties include but are not limited to:
·Receive pending claims for evaluation and processing
Medical Reviewer Jobs
By EPM Scientific At New Jersey, United States
Knowledge of International and US Regulatory Requirements
Evaluates case reportability per local regulatory requirements and meets appropriate timelines for case review
3+ years previous experience in medical review
Knowledge of disease pathology and physiology, pharmacology and therapeutics
Strong organizational, written and verbal communication skills
Previous experience using a Pharmacovigilance Database
Medical Reviewer Ii Jobs
By BlueCross BlueShield of South Carolina At South Carolina, United States
Continuing education funds for additional certifications and certification renewal.
Working knowledge of word processing software.
Demonstrated customer service and organizational skills.
Demonstrated oral and written communication skills.
Analytical or critical thinking skills.
Educates internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines.
Medical Claims Reviewer, Associate (Remote U.s.)
By Acentra Health At United States
Required Technology Skills / Qualifications / Experience:
Comprehensive knowledge of medical coding systems, procedures, and documentation requirements.
Demonstrates basic knowledge of medical coding systems, procedures, and documentation requirements.
Are you an experienced Medical Claims Reviewer, Associate looking for a new challenge?
Knowledge of auditing concepts and principles.
Knowledge of statutory regulations and medical terminology.
Medical Records Reviewer - Remote | Wfh
By Get It Recruit - Healthcare At Harrisburg, PA, United States

Comprehensive benefits accessible to full-time team members after 90 days of tenure Full-time employees with 1 year of service can participate in our 401(k) program with company matching Highlights ...

Medical Researcher & Reviewer Jobs
By hims & hers At United States
3+ years of professional medical research experience
Comprehensive health benefits including medical, dental & vision, and parental leave
401k benefits with employer matching contribution
At a high level, there are two key responsibilities:
Our Benefits (there are more but here are some highlights):
Vet sources based on Hims & Hers medical research guidelines
Remote Medical Claims Analyst
By Aspirion Health Resources LLC At , Remote $16.11 - $20.00 an hour
Cross train in multiple areas and perform all other duties as assigned by management.
Time management and reliable attendance
Bachelor's degree preferred, or equivalent combination of education, training, and experience
Investigate and coordinate insurance benefits for insurance claims across multiple service lines.
Review and understand eligibility of benefits.
Demonstrate excellent customer service, communication skills, creativity, patience, and flexibility.
Medical Benefits Reviewer 5-E7
By State of Michigan At , Lansing, 48933 $18.45 - $26.12 an hour
Alternative and Remote Work Schedules:
A secure work location that allows privacy and prevents distractions.
A high-speed internet connection of at least 25 Mbps download and 5 Mbps upload.
Suitable lighting, furniture, and utilities
Health and Human Services - Central Office
To be considered for this position you must:
Freelance Drug Content Medical Reviewer
By RVO Health Freelance Network At , New York $100 an hour
Experience writing, editing, or reviewing drug-related content for consumers* — 2 or more samples required
Please note that experience with clinical drug content is not what we're looking for
we need experience with content written for laypeople who don't understand drugs.
Review each article (of ~1,500–4,000 words) in its entirety
Make sure the article is comprehensive and not missing any key content
Make suggestions for revised content that's written at an 8th–10th grade reading level and understandable to laypeople
Clinical Claims Specialist Medical
By Wellpath At United States
5 years in a correctional healthcare setting, hospital management, risk management, insurance, claims management, or similar experience required.
Experience with data management, statistics, analytics, process improvement methodology, and PC applications preferred.
Patient care, legal or claims management experience is preferred.
Take on special projects involving data gathering, report preparation, trend management, and escalation related to risk management.
Bachelor's degree is preferred. Health administration, management, business administration, claims management, insurance, or related field preferred.
Previously demonstrated ability and experience in providing leadership for self-directed work teams.
Medical Reviewer Iii Jobs
By BlueCross BlueShield of South Carolina At , Nashville, 37214
Assists with special projects and specialty duties/responsibilities as assigned by Management.
Continuing education funds for additional certifications and certification renewal.
Provides education to non-medical staff through discussions, team meetings, classroom participation and feedback.
FOR PALMETTO GBA (CO. 033) ONLY: two years clinical experience plus two years utilization/medical review, quality assurance, OR home health experience.
Knowledge of specific criteria/protocol sets and the use of the same.
Working knowledge of word processing software.
Medical Reviewer/Safety Reviewer/Rn/Pharmacist
By KYYBA Inc At North Chicago, IL, United States
What are the top 5 skills/requirements this person is required have?
Required Skill 3: Ability to apply clinical knowledge to adverse event data collection and data assessment.
Required Skill 1: Competent understanding of ICH/FDA regulations and guidelines affecting drug / device safety issues preferred.
Required Skill 2: Strong critical thinking skills
Required Skill 4: Ability to present accurate and medically sound safety data, both orally and in writing.
Length of the assignment: 1 year possible extension
Medical Claims Analyst - Atrix Ally
By Cardinal Health At , $24.70 - $36.90 an hour
Extensive patient education/counseling to determine eligibility for Advocacy.
Manage the drug recovery application process
Demonstrates extensive knowledge and understanding of relevant clinical operations, products and services
Develops, plans and manages customer training programs in multi-site and/or complex environments
0 - 2 years of experience in related field preferred (open to fresh graduates!)
Strong Microsoft Office skills (Excel, Word, Outlook)
Appeals Medical Reviewer (Rn Required)
By HCSC At , Helena
Experience in Utilization Management or audit.
5 years clinical experience to include implementing or administering managed care or quality assurance activities.
Knowledge and understanding of associated state and federal guidelines
This role is telecmmute,100% remote
Registered Nurse (RN) with current unrestricted license in good standing in state of operations.
Ability to work alone in a fast paced, demanding environment and impacting members.
Medical Coding Reviewer Ii
By Michigan Health Plan At , , Mi

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll ...

Lpn Clinical Claims Reviewer (Hybrid/Remote Position)
By Chapters Health System At , Temple Terrace, 33637, Fl
Ensures departmental compliance with quality managements system and ISO requirements.
Improve own professional knowledge and skill level.
Minimum of two (2) years of hospice, palliative care, home health primary, and specialty care experience
Familiarity with Medicare, Medicaid, commercial and CMS managed care initiatives
Experience in Microsoft Outlook, Excel and Word
Excellent written and verbal communication skills
Medical Reviewer Jobs
By Zenith LifeScience At , South Plainfield, Nj $100,000 - $120,000 a year
In conjunction with pharmacovigilance scientists and physicians contribute to writing and maintaining Risk Management Plans.
Manage review of cases according to internal timelines
Experience in process improvement initiatives
Extensive knowledge of US, ICH and EU PV and GCP regulations
Excellent strategic decision-making and analytical skills
Computer skills including proficiency in use of Microsoft Word, Excel & PowerPoint
Medical Reviewer (Entry Level)
By GForce Life Sciences At Columbus, Ohio Metropolitan Area, United States
Collecting, assessing and processing adverse event information in a compliant and timely manner in order to meet applicable regulatory requirements.
0-3 years related experience (Some industry experience desirable.)
Clinical knowledge to apply to adverse event data collection and/or medical/product assessments.
Benefits: Medical, Dental, and Vision
Coding cases using appropriate dictionary, searching and inputting data in electronic databases.
Generating, tracking and resolving adverse event follow-up/distribution correspondence; managing adverse event reports from initial cases and follow-up.
Medical Claims Representative Jobs
By Morgan Stephens At Irving, TX, United States

Morgan Stephens ofrecemos reclutadores que hablan Espanol

Medical Reviewer Jobs
By GForce Life Sciences At Columbus, Ohio Metropolitan Area, United States
Collecting, assessing and processing adverse event information in a compliant and timely manner in order to meet applicable regulatory requirements.
0-3 years related experience (Some industry experience desirable.)
Clinical knowledge to apply to adverse event data collection and/or medical/product assessments.
Benefits: Medical, Dental, and Vision
Coding cases using appropriate dictionary, searching and inputting data in electronic databases.
Generating, tracking and resolving adverse event follow-up/distribution correspondence; managing adverse event reports from initial cases and follow-up.

Are you looking for a job that combines your medical knowledge with your attention to detail? We are looking for a Medical Claims Reviewer to join our team! You will be responsible for reviewing medical claims to ensure accuracy and compliance with applicable laws and regulations. If you have a passion for medical claims and want to make a difference, this is the job for you!

Overview:

A Medical Claims Reviewer is responsible for reviewing medical claims to ensure accuracy and compliance with insurance policies and regulations. They must have a thorough understanding of medical terminology, coding, and billing procedures. They must also be able to identify discrepancies and errors in claims and take appropriate action to resolve them.

Detailed Job Description:

A Medical Claims Reviewer is responsible for reviewing medical claims to ensure accuracy and compliance with insurance policies and regulations. They must have a thorough understanding of medical terminology, coding, and billing procedures. They must also be able to identify discrepancies and errors in claims and take appropriate action to resolve them. They must be able to interpret and analyze medical records, insurance policies, and other documents related to the claims. They must also be able to communicate effectively with providers, patients, and insurance companies.

What is Medical Claims Reviewer Job Skills Required?

• Knowledge of medical terminology, coding, and billing procedures
• Ability to interpret and analyze medical records, insurance policies, and other documents related to the claims
• Ability to identify discrepancies and errors in claims
• Ability to communicate effectively with providers, patients, and insurance companies
• Knowledge of relevant laws and regulations
• Ability to work independently and as part of a team
• Attention to detail
• Organizational skills
• Computer skills

What is Medical Claims Reviewer Job Qualifications?

• Bachelor’s degree in a related field
• Certification in medical coding and/or billing
• Previous experience in medical claims review
• Knowledge of relevant laws and regulations

What is Medical Claims Reviewer Job Knowledge?

• Knowledge of medical terminology, coding, and billing procedures
• Knowledge of relevant laws and regulations
• Knowledge of medical records and insurance policies

What is Medical Claims Reviewer Job Experience?

• Previous experience in medical claims review
• Experience working with providers, patients, and insurance companies

What is Medical Claims Reviewer Job Responsibilities?

• Review medical claims to ensure accuracy and compliance with insurance policies and regulations
• Interpret and analyze medical records, insurance policies, and other documents related to the claims
• Identify discrepancies and errors in claims and take appropriate action to resolve them
• Communicate effectively with providers, patients, and insurance companies
• Ensure compliance with relevant laws and regulations
• Maintain accurate records of claims review process