Baltimore, MD · On-site
$36.49 - $41.49/hr
Pay Range: $36.49hr - $41.49hr Responsibilities Review, research, and analyze professional and institutional claims using clinical judgment and medical policies for accurate adjudication. Conduct ...
Baltimore, MD · On-site
$36.49 - $41.49/hr
Pay Range: $36.49hr - $41.49hr Responsibilities Review, research, and analyze professional and institutional claims using clinical judgment and medical policies for accurate adjudication. Conduct ...
$142K - $170K/yr
Help with pharmacy claims adjudication, benefit and formulary problems generated from external and ... Equivalent to two years of work in a clinical pharmacy. Managed care and drug information center ...
$142K - $170K/yr
Help with pharmacy claims adjudication, benefit and formulary problems generated from external and ... Equivalent to two years of work in a clinical pharmacy. Managed care and drug information center ...
California, MO · On-site
$110 - $160/hr
Manages protocol and ICF development process with minimal guidance; including writing, reviewing, adjudication/resolution of cross functional comments and ensuring high clinical quality ...
California, MO · On-site
$110 - $160/hr
Manages protocol and ICF development process with minimal guidance; including writing, reviewing, adjudication/resolution of cross functional comments and ensuring high clinical quality ...
Jay, OK · On-site
Overview GENERAL DESCRIPTION Provides clinical and administrative support to healthcare providers ... adjudication for childcare. • Adheres to all organizational policies, including confidentiality ...
Jay, OK · On-site
Overview GENERAL DESCRIPTION Provides clinical and administrative support to healthcare providers ... adjudication for childcare. • Adheres to all organizational policies, including confidentiality ...
Muskogee, OK · On-site
Overview GENERAL DESCRIPTION Provides clinical and administrative support to healthcare providers ... adjudication for childcare. • Adheres to all organizational policies, including confidentiality ...
Muskogee, OK · On-site
Overview GENERAL DESCRIPTION Provides clinical and administrative support to healthcare providers ... adjudication for childcare. • Adheres to all organizational policies, including confidentiality ...
Partner with the Configuration and Data Science teams to ensure that clinical and reimbursement policy intent is perfectly synchronized with technical adjudication. * Cross-Functional Influence: Act ...
Partner with the Configuration and Data Science teams to ensure that clinical and reimbursement policy intent is perfectly synchronized with technical adjudication. * Cross-Functional Influence: Act ...
Partners with Clinical Scientists to support executional delivery of studies (e.g., site activation, enrollment status, as well as adjudication for protocol violations, significant, non-significant ...
Partners with Clinical Scientists to support executional delivery of studies (e.g., site activation, enrollment status, as well as adjudication for protocol violations, significant, non-significant ...
Partners with Clinical Scientists to support executional delivery of studies (e.g., site activation, enrollment status, as well as adjudication for protocol violations, significant, non-significant ...
Partners with Clinical Scientists to support executional delivery of studies (e.g., site activation, enrollment status, as well as adjudication for protocol violations, significant, non-significant ...
Jericho, NY · On-site
$27 - $29/hr
Someone who has claims adjudication or claims processing experience, a medical auditor or medical ... Review medical records, itemized bills, clinical documentation, and related materials to determine ...
Jericho, NY · On-site
$27 - $29/hr
Someone who has claims adjudication or claims processing experience, a medical auditor or medical ... Review medical records, itemized bills, clinical documentation, and related materials to determine ...
Leawood, KS · On-site
$115K - $137K/yr
Clinical Pharmacist - Sales McKesson is an impact-driven, Fortune 10 company that touches virtually ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
Leawood, KS · On-site
$115K - $137K/yr
Clinical Pharmacist - Sales McKesson is an impact-driven, Fortune 10 company that touches virtually ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
$115K - $137K/yr
The Clinical Pharmacist also provides industry guidance and support to the Revenue Demand ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
$115K - $137K/yr
The Clinical Pharmacist also provides industry guidance and support to the Revenue Demand ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
Irving, TX · On-site
$113K - $135K/yr
The Clinical Pharmacist also provides industry guidance and support to the Revenue Demand ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
Irving, TX · On-site
$113K - $135K/yr
The Clinical Pharmacist also provides industry guidance and support to the Revenue Demand ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
$114K - $136K/yr
The Clinical Pharmacist also provides industry guidance and support to the Revenue Demand ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
$114K - $136K/yr
The Clinical Pharmacist also provides industry guidance and support to the Revenue Demand ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
Brisbane, CA · On-site
$96K - $131K/yr
Partners with Clinical Scientists to support executional delivery of studies (e.g., site activation, enrollment status, as well as adjudication for protocol violations, significant, non-significant ...
Brisbane, CA · On-site
$96K - $131K/yr
Partners with Clinical Scientists to support executional delivery of studies (e.g., site activation, enrollment status, as well as adjudication for protocol violations, significant, non-significant ...
Overland Park, KS · On-site
$117K - $139K/yr
The Clinical Pharmacist also provides industry guidance and support to the Revenue Demand ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
Overland Park, KS · On-site
$117K - $139K/yr
The Clinical Pharmacist also provides industry guidance and support to the Revenue Demand ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
Partners with Clinical Scientists to support executional delivery of studies (e.g., site activation, enrollment status, as well as adjudication for protocol violations, significant, non-significant ...
Partners with Clinical Scientists to support executional delivery of studies (e.g., site activation, enrollment status, as well as adjudication for protocol violations, significant, non-significant ...
Alpharetta, GA · On-site
$115K - $138K/yr
The Clinical Pharmacist also provides industry guidance and support to the Revenue Demand ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
Alpharetta, GA · On-site
$115K - $138K/yr
The Clinical Pharmacist also provides industry guidance and support to the Revenue Demand ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
$113K - $135K/yr
The Clinical Pharmacist also provides industry guidance and support to the Revenue Demand ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
$113K - $135K/yr
The Clinical Pharmacist also provides industry guidance and support to the Revenue Demand ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
$114K - $136K/yr
The Clinical Pharmacist also provides industry guidance and support to the Revenue Demand ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
$114K - $136K/yr
The Clinical Pharmacist also provides industry guidance and support to the Revenue Demand ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
Irving, TX · On-site
$113K - $135K/yr
Clinical Pharmacist - Sales McKesson is an impact-driven, Fortune 10 company that touches virtually ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
Irving, TX · On-site
$113K - $135K/yr
Clinical Pharmacist - Sales McKesson is an impact-driven, Fortune 10 company that touches virtually ... adjudication platforms Preferred Skills / Experience * Experience and demonstrated success in a ...
$12.02 - $17.26
0% of jobs
$17.26 - $22.51
8% of jobs
$22.51 - $27.75
13% of jobs
$29.16 is the 25th percentile. Wages below this are outliers.
$27.75 - $33
15% of jobs
$33 - $38.24
13% of jobs
The median wage is $39.03 / hr.
$38.24 - $43.49
11% of jobs
$43.49 - $48.73
12% of jobs
$50.59 is the 75th percentile. Wages above this are outliers.
$48.73 - $53.98
13% of jobs
$53.98 - $59.22
14% of jobs
$59.22 - $64.47
2% of jobs
$64.47 - $69.71
1% of jobs
$12
$41
$69
| Aspect | Clinical Adjudication | Medical Claims Reviewer |
|---|---|---|
| Credentials | Certifications in healthcare, clinical knowledge | Insurance, claims processing certifications |
| Work Environment | Hospitals, healthcare facilities, insurance companies | Insurance companies, third-party administrators |
| Industry Usage | Healthcare, insurance | Insurance, healthcare |
| Job Focus | Assessing clinical validity of claims, medical necessity | Reviewing claim documentation for accuracy and compliance |
While both roles involve reviewing medical information, Clinical Adjudication focuses on determining the medical necessity and validity of claims based on clinical criteria, often requiring healthcare knowledge. Medical Claims Reviewers primarily verify documentation accuracy and compliance with insurance policies. Understanding these distinctions helps clarify career paths and employer expectations in healthcare and insurance industries.
$36.49 - $41.49/hr
Other
Re-posted 5 days ago
Job Overview: Pay Range: $36.49hr - $41.49hr
ResponsibilitiesReview, research, and analyze professional and institutional claims using clinical judgment and medical policies for accurate adjudication.
Conduct high-level research on medical topics and assess impact on medical policy development.
Provide pricing for procedure codes requiring individual consideration or classified as “not otherwise specified” using CPT and HCPCS guidelines.
Interpret medical and procedural information in alignment with coding standards and regulatory requirements.
Participate in medical policy meetings, nursing forums, and review sessions with medical and dental leadership.
Contribute to special projects, task forces, and cross-functional initiatives.
Perform medical underwriting and risk assessment by reviewing applications and medical records of potential members.
Required QualificationsMinimum 3 years of acute clinical experience.
Experience in case management, discharge planning, or utilization review.
Strong understanding of clinical practices and medical policy application.
Proficiency in Microsoft Office (Excel, Word, PowerPoint) and web-based systems.
Experience working with Electronic Medical Records (EMR) systems.
Excellent verbal and written communication skills.
Preferred QualificationsBachelor’s degree in Nursing.
Key SkillsClinical claims review and adjudication.
Medical coding knowledge (CPT, HCPCS).
Medical policy analysis and research.
Risk assessment and underwriting support.
Strong analytical and critical thinking abilities.
Attention to detail and organizational skills.
Ability to work independently and collaboratively.
Customer service and stakeholder communication.
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Cynet Systems Inc is a staffing and recruiting corporation nestled in Ashburn, VA, USA. Established in 2010, the company operates within the Information Technology and Services sector, specializing in providing effective workforce solutions to different business needs, including IT consulting, direct hire, and contract staffing services. Through the years, Cynet Systems has built an impressive portfolio, going beyond borders and expanding its operations internationally in Canada and India. Rooted in its core values of teamwork, leadership, and commitment, Cynet Systems helps businesses unlock their full potential by providing versatile and competent professionals that perfectly align with their needs. Fueled by their unwavering mission to deliver top-tier talent to businesses worldwide, Cynet Systems garnered various recognitions including SIA's fastest-growing staffing firms and Best Place to Work in Virginia for 2019.
It services
501 - 1,000 Employees
Sterling, VA, US
2010
