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Pro Fee Quality Reviewer Jobs

Quality Reviewer, Rn Jobs
By Atlantic Health System At , Morristown, 07960
Position is responsible for review of clinical documentation of home care clinicians after admissions, recertifications, resumptions of care and discharge.
Minimum of 3 years of certified home care experience
Experience in OASIS review and coding highly desirable
Utilize decision software to assure OASIS assessment is completed accurately
Follows PDGM guidelines regarding coding with accuracy
Coach clinical staff on documentation accuracy
Senior Quality Reviewer Jobs
By Blue Cross Blue Shield of Louisiana At , Baton Rouge, 70806
Mentors and trains less experienced staff and complete special assignments as requested by management. Assists staff with complex questions and issues.
Must have strong organizational and analytical abilities and effective interpersonal skills.
This role does not manage people
Must have knowledge in the processes and produces (i.e., claims processing and/or enrollment coding) is required
Must demonstrate verbal and communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism.
Must have working knowledge about plan products, company initiatives and other operational changes affecting the department.
Recreation Fee Technician Jobs
By US National Park Service At , Great Falls, Va $42,870 - $55,736 a year
If you are relying on your education to meet qualification requirements:
Meet Selective Service Registration Act requirement for males.
College transcripts, if qualifying based on education.
You will be evaluated for this job based on how well you meet the qualifications above.
Calculate costs, making change, and/or processing credit card transactions for customer purchases/payments.
Accurately complete daily shift accounting reports for sales.
Quality Assurance Reviewer 1 Jobs
By State of Georgia At DeKalb County, GA, United States
Enhances skill and knowledge of all DAS staff by providing both formal and informal training as needed and assigned.
Two (2) years of experience processing Continuing Disability Reviews (CDR’s) and Disabled Children (DC) claims.
Excellent presentation, verbal, and written communication skills
Serves as a quality assurance reviewer conducting in-development, end-of-line, and rebuttal reviews on all case types (except DHU hearings).
Serves as resource to Claims Processing staff providing consultation and technical assistance to staff and other DAS departments.
Participates in special projects, DAS pilots, and performs other duties as assigned.
Rn Quality Assurance Reviewer
By Vatica Health At Alpharetta, GA, United States
QA data management and strategic planning for upcoming needs
Competitive salary based on your experience and skills – we believe the top talent deserves the top dollar
Manage structured QA audits and subsequent remediation
Registered nurse with minimum of 3 years of clinical experience
Excellent organizational skills with the ability to multi-task and pivot with organizational needs.
Work closely with Clinical Training to identify and remediate RNs/APPs QA within weeks 4 through 12 of new hire orientation
Pro Fee Coder- Radiology
By Savista At , Remote $22.08 - $34.69 an hour
Participate in continuing education activities to enhance knowledge, skills, and maintain current credentials.
Maintain current working knowledge of ICD-10 and/or CPT/HCPCS and coding guidelines, government regulations, protocols and third-party requirements regarding coding and/or billing.
Associates degree in HIM or healthcare-related field, or combination of equivalent education and experience
Candidates must successfully pass pre-employment skills assessment. Required:
Two years of recent and relevant hands-on coding experience
Knowledge of medical terminology, anatomy and physiology, pharmacology, pathophysiology, as well as ICD-10 and CPT/HCPCS code sets
Coder Ii - Pro-Fee Obgyn
By Acclara At , Remote $15 - $35 an hour
Maintains knowledge of the current changes of coding practices by continuing education and reading resource material
Cooperates fully in all risk management and compliance activities and investigations for QM purposes.
2+ years coding experience required in clinic and/or professional coding.
Possess strong written and verbal communication skills to communicate effectively with stakeholders at all levels of the organization
Possess excellent telephone etiquette, presentation skills and problem resolution skills
Computer skills including Microsoft Office Suite
Quality Reviewer - Remote
By ABS Kids At , Tulsa, 74101, Ok $18 - $19 an hour
$18.00 - $19.00 / hour - based on qualifications
Knowledge and familiarity with company-wide systems (e.g., Central Reach, Microsoft Office)
Take initiative to seek clarification and support when needed to fulfill responsibilities
Support internal and external ABS Kids' audits
Review designated BT Direct Care Session Notes and evaluate based on a compliance and quality standards rubric
Accurately record data in a database
Fee For Service Children’s Therapist
By Family Residences and Essential Enterprises At , Oakdale, 11769, Ny
Assist the Clinic Management in reporting activities including but not limited to Pscykes, OMH, Financial and County reporting requirements.
Maintain and complete responsibilities of client caseload including but not limited, treatment plans, progress notes and assessments
At least 2 years’ experience providing individual, group or family therapy to individuals with mental illness to children.
Effectively communicate and support the organization’s mission, vision and values
See individuals for initial assessments and routine appointments
Ensure documentation meets quality and compliance thresholds as set by regulation and/or Agency guidelines
Pro Fee Coder - Hospitalist
By Savista At , Remote $22.08 - $34.69 an hour
Participate in continuing education activities to enhance knowledge, skills, and maintain current credentials.
Maintain current working knowledge of ICD-10 and/or CPT/HCPCS and coding guidelines, government regulations, protocols and third-party requirements regarding coding and/or billing.
Associates degree in HIM or healthcare-related field, or combination of equivalent education and experience
Candidates must successfully pass pre-employment skills assessment. Required:
Two years of recent and relevant hands-on coding experience
Knowledge of medical terminology, anatomy and physiology, pharmacology, pathophysiology, as well as ICD-10 and CPT/HCPCS code sets
Pro Fee Coder - Cardiology
By Savista At , Remote $22.08 - $34.69 an hour
Participate in continuing education activities to enhance knowledge, skills, and maintain current credentials.
Maintain current working knowledge of ICD-10 and/or CPT/HCPCS and coding guidelines, government regulations, protocols and third-party requirements regarding coding and/or billing.
Associates degree in HIM or healthcare-related field, or combination of equivalent education and experience
Candidates must successfully pass pre-employment skills assessment. Required:
Two years of recent and relevant hands-on coding experience
Knowledge of medical terminology, anatomy and physiology, pharmacology, pathophysiology, as well as ICD-10 and CPT/HCPCS code sets
Pro Fee Coder - Anesthesia
By Savista At , Remote $22.08 - $34.69 an hour
Participate in continuing education activities to enhance knowledge, skills, and maintain current credentials.
Maintain current working knowledge of ICD-10 and/or CPT/HCPCS and coding guidelines, government regulations, protocols and third-party requirements regarding coding and/or billing.
Associates degree in HIM or healthcare-related field, or combination of equivalent education and experience
Candidates must successfully pass pre-employment skills assessment. Required:
One (2) years of recent and relevant hands-on coding experience
Knowledge of medical terminology, anatomy and physiology, pharmacology, pathophysiology, as well as ICD-10 and CPT/HCPCS code sets
Coding Quality Reviewer Jobs
By Children's Hospital Colorado At , Aurora, Co $57,781 - $86,671 a year
Experience: Minimum 2 years of Health Information Management (HIM) experience.
5. Demonstrates coding knowledge and skill by maintaining coding credentials or pursuing advanced credentials.
Education: Associates degree in related field.
6. Develops and presents educational training to coders, physicians, staff, and clinical documentation integrity specialists.
Here, it’s different. Come join us
Children's Hospital Colorado has defined and delivered pediatric healthcare excellence for more than 100 years.
Quality Control Reviewer Jobs
By HaystackID At , Remote $65,000 - $85,000 a year
Work closely with the Review Manager and production staff to ensure proper allocation of resources based on deadlines and priorities.
Assist with document review team questions or escalate to Review Manager
Manage work progress and provide feedback to document review team
Technical experience in eDiscovery platforms and tools
Strong technical understanding and/or experience with eDiscovery process, life cycle, and technical issues
Software application proficiency with Microsoft Office, including intermediate Excel skills
Provider Educator/Quality Reviewer
By Vatica Health At Alpharetta, GA, United States
Experience in a clinical care setting (preferred settings: internal medicine, critical care management, and/or intensive care)
Competitive salary based on your experience and skills – we believe the top talent deserves the top dollar.
Maintains Vatica Health Provider Education Department Standards of Practice.
Produces effective provider education materials.
Schedules and conducts provider education sessions.
A certified Nurse Practitioner (NP) or Physician Assistant (PA) with considerable clinical experience (3 to 5 years preferred.)
Coder Ii - Pro-Fee - Hospitalist
By Acclara At , Remote $15 - $35 an hour
Maintains knowledge of the current changes of coding practices by continuing education and reading resource material
Cooperates fully in all risk management and compliance activities and investigations for QM purposes.
2 years of coding experience required in clinic and/or professional coding.
For cardiology positions, CIRCC certification is a plus.
Possess strong written and verbal communication skills to communicate effectively with stakeholders at all levels of the organization
Possess excellent telephone etiquette, presentation skills and problem resolution skills
Agrisompo Quality Control Reviewer (R1074)
By AgriSompo At , Bismarck, Nd From $55,000 a year
Proficient computer skills, including working knowledge of Microsoft Office Suite.
Tuition Reimbursement & Professional Qualification benefits.
Perform reviews pursuant to the requirements of the SRA including but not limited to Appendix IV
Pharmacy benefits with mail order options.
Dental benefits including orthodontia benefits for adults and children.
Company-paid Life & AD&D benefits, including the option to purchase Supplemental life coverage for employee, spouse & children.
Fee For Service Lpn
By MJHS At , New York, Ny $48 an hour
Minimum of one year Med/surg experience in a hospital or Longterm Care facility required.
NY State LPN License required
Must have a NY State Drivers License and a car.
MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)
Weekend / Holiday visit rate: $55
Bilingual Quality Assurance Reviewer
By Qlarant At Miami, FL, United States
Initiates contact with service providers to establish interview and review schedules and discuss associated protocols, expectations, and responsibilities.
Analytical – Gathers and analyzes information skillfully; Develops alternative solutions.
Conducts detailed evaluation of provider performance and the presence of person-centered supports using applicable tools and guidelines.
Conducts interviews with individuals with an intellectual or developmental disability, providers of services and/or direct service staff.
Observes the service environment and follow professional protocols to gather pertinent information and makes decisions for the evaluation process.
Establishes and maintains a positive and respectful approach with individuals/family members/providers/support coordinators throughout the review process.
Fee For Service Lpn
By Metropolitan Jewish Health System At , New York, 10001, Ny $48 an hour
Minimum of one year Med/surg experience in a hospital or Longterm Care facility required.
NY State LPN License required
Must have a NY State Drivers License and a car.
Weekend / Holiday visit rate: $55

Are you looking for an opportunity to use your expertise to review and assess the quality of products? We are looking for a Pro Fee Quality Reviewer to join our team and help us ensure that our products meet the highest standards of quality. As a Pro Fee Quality Reviewer, you will be responsible for evaluating the quality of products and providing feedback to ensure that they meet our standards. If you have a keen eye for detail and a passion for quality assurance, this could be the perfect job for you!

Overview:

A Pro Fee Quality Reviewer is responsible for ensuring that all professional fee claims are accurate and compliant with applicable regulations. They review claims for accuracy and completeness, and ensure that all documentation is in order. They also provide guidance to providers on how to properly submit claims and provide feedback on any errors or discrepancies.

Detailed Job Description:

The Pro Fee Quality Reviewer is responsible for reviewing professional fee claims for accuracy and completeness. They must ensure that all documentation is in order and that all claims are compliant with applicable regulations. They must also provide guidance to providers on how to properly submit claims and provide feedback on any errors or discrepancies. The Pro Fee Quality Reviewer must also be able to identify and resolve any issues that arise during the review process.

What is Pro Fee Quality Reviewer Job Skills Required?

• Knowledge of professional fee claims and regulations
• Excellent attention to detail
• Strong organizational and problem-solving skills
• Ability to work independently and as part of a team
• Excellent communication and interpersonal skills
• Ability to multitask and prioritize tasks

What is Pro Fee Quality Reviewer Job Qualifications?

• Bachelor’s degree in a related field
• At least two years of experience in a related field
• Knowledge of medical coding and billing
• Knowledge of medical terminology
• Knowledge of healthcare regulations

What is Pro Fee Quality Reviewer Job Knowledge?

• Knowledge of professional fee claims and regulations
• Knowledge of medical coding and billing
• Knowledge of medical terminology
• Knowledge of healthcare regulations

What is Pro Fee Quality Reviewer Job Experience?

• At least two years of experience in a related field
• Experience in reviewing professional fee claims
• Experience in providing guidance to providers on how to properly submit claims

What is Pro Fee Quality Reviewer Job Responsibilities?

• Review professional fee claims for accuracy and completeness
• Ensure that all documentation is in order and that all claims are compliant with applicable regulations
• Provide guidance to providers on how to properly submit claims
• Identify and resolve any issues that arise during the review process
• Provide feedback on any errors or discrepancies
• Maintain accurate records of all reviews and claims