Medical Claims Review Jobs (NOW HIRING)

This position for a medical claims review nurse on the World Trade Center (WTC) Health Program will have a direct impact on members of the program. The nurse will be responsible for reviewing claims ...

This position for a medical claims review nurse on the World Trade Center (WTC) Health Program will have a direct impact on members of the program. The nurse will be responsible for reviewing claims ...

Conducts medical claims review using current claims processing guidelines and established clinical criteria e.g. CDST and policy keys, to evaluate medical necessity, appropriateness of care and ...

Selected individuals will perform medical claims review activities, receive and process treatment requests, and provide guidance to treatment facilities. Primary Responsibilities * Perform medical ...

Join MedPOINT Management as a Medical Claims Clinical Review Nurse in Sherman Oaks, CA, where you'll play a crucial role in ensuring the quality and accuracy of medical claims. This is an exciting ...

Role : Conduct retrospective review of medical, surgical, and behavioral health claims. * Focus : Evaluate claims for medical necessity, appropriateness, and adherence to program benefits.

Claims Medical Review Nursing Consultant Job No: 541707 Work Type: Full-time Location: REMOTE OPTIONS, VARIOUS-STATEWIDE, PHOENIX Categories: Healthcare/Medical Professional Level, Healthcare/Medical ...

Review medical, dental, and pharmacy claims for International Military Students (IMS) and their dependents against payer policies, ICD-10 coding guidelines, and medical necessity standards. * Receive ...

Review medical, dental, and pharmacy claims for International Military Students (IMS) and their dependents against payer policies, ICD-10 coding guidelines, and medical necessity standards. * Receive ...

Review medical, dental, and pharmacy claims for International Military Students (IMS) and their dependents against payer policies, ICD-10 coding guidelines, and medical necessity standards. * Receive ...

Review medical, dental, and pharmacy claims for International Military Students (IMS) and their dependents against payer policies, ICD-10 coding guidelines, and medical necessity standards. * Receive ...

Review medical, dental, and pharmacy claims for International Military Students (IMS) and their dependents against payer policies, ICD-10 coding guidelines, and medical necessity standards. * Receive ...

Review medical, dental, and pharmacy claims for International Military Students (IMS) and their dependents against payer policies, ICD-10 coding guidelines, and medical necessity standards. * Receive ...

Responsibilities: • Review, evaluate, and process medical claims with close attention to accuracy, completeness, and applicable coverage details. • Enter and maintain member, enrollment ...

Review and process medical claims to ensure accurate billing and reimbursement * Enter and update claim information across multiple systems with accuracy * Follow up on outstanding claims to maximize ...

Here at Optum, we have an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers ...

Review medical claims and transmit to the insurance carrier using the practice electronic health records (EHR) system and clearing house. * Monitor rejected claim reports and adjust claims for ...

Here at Optum, we have an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers ...

Review collection queues, Explanation of Benefits (EOBs), and correspondence for unpaid or underpaid claims. * Research claim issues and resolve discrepancies appropriately. * Interpret EOBs and ...

Here at Optum, we have an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers ...