Under the general direction of the NIPR Manager or designee, Clinical Reviewer Auditor is tasked with the responsibility to perform and oversee retrospective, post-payment case reviews of community-based providers who participate in MassHealth. The Clinical Reviewer Auditor works within specific gui...
Clinical Nurse Reviewer - NIPR (Hybrid - North Quincy, MA). Under the general direction of the NIPR Manager or designee, Clinical Reviewer Auditor is tasked with the responsibility to perform and oversee retrospective, post-payment case reviews of community-based providers who participate in MassHea...
The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments. ...
What You’ll Be Doing:As a Cardiology, Physician Clinical Reviewer you will be a key member of the utilization management team. As well as, aids and acts as a resource to Initial Clinical Reviewers. What You Will Be Doing:Serve as the specialty match reviewer in Cardiology cases, that do not initiall...
The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines and rules, evidence based clinical criteria plan, and policy exclusions. ...
The team has identified that they will need to add five highly qualified document reviewers to their growing team who have prior documentation review experience and good documentation practice experience as well. ...
At Zelis, the Itemized Bill Review Facility Reviewer is responsible for analyzing facility inpatient and outpatient claims for Health Plans and ensuring adherence to proper billing guidelines. ...
Incumbent serves as a Revenue Officer Advisor/Reviewer who has the responsibility for various program areas within AIQ Advisory and Collection. The Advisor/Reviewer is also responsible for organizing and coordinating the efforts of Service employees and other involved parties to protect the Governme...
At Zelis, the Itemized Bill Review Facility Reviewer is responsible for analyzing facility inpatient and outpatient claims for Health Plans and ensuring adherence to proper billing guidelines. ...
AMENDED TO INCLUDE CUTOFF DATES 9/16/2024, 10/15/2024 and 11/15/2024.Click on Learn more about this agency button below to view Eligibilities being considered and other IMPORTANT information.WHERE CAN I FIND OUT MORE ABOUT OTHER IRS CAREERS? Visit us on the web at www.Career transition (CTAP, ICTAP,...
Nurse Reviewer, Endoscopy -Braintree-(3288945). Under the direction of the Nurse Director of the BWPO’s South Shore Endoscopy Center (SSEC), the Registered Nurse GI Case Reviewer will work as a critical member of the procedural care team to support the quality, efficiency and satisfaction of care ta...
Specialist Staffing Group is an equal opportunity employer.All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status....
In this exciting position the content reviewer will localize, translate and adapt the content of various categories (i. ...
Under the general direction of the NIPR Manager or designee, Clinical Reviewer Auditor is tasked with the responsibility to perform and oversee retrospective, post-payment case reviews of community-based providers who participate in MassHealth. The Clinical Reviewer Auditor works within specific gui...
As a Medical Audit Claim Reviewer, you will play a crucial role in our organization by reviewing and auditing medical claims to ensure compliance with policies, procedures, and regulatory requirements. ...
Why This Role is Important to Us.Reporting to the VP Quality & Controls Assurance, the incumbent is responsible for independent quality reviews of medical claims, and evaluating Call Center activities for compliance with policies and Standard Operating Procedures (SOP).Additionally, this role will r...
Travel Expenses Reviewer - hybrid - $25/hr. We’re looking for adetail-oriented Travel Expenses Reviewer to join a supportive, collaborativeteam at a prestigious university. ...
Nurse Reviewer, Endoscopy -Braintree-(3288945). Under the direction of the Nurse Director of the BWPO’s South Shore Endoscopy Center (SSEC), the Registered Nurse GI Case Reviewer will work as a critical member of the procedural care team to support the quality, efficiency and satisfaction of care ta...
We have an ongoing need for Document Reviewers. Document Reviewers will review documents for complex litigation matters using an electronic review platform to code for relevancy, confidentiality, and privilege. ...
Boston, MA (on-site 5 days per week).GMP/GDP lab or lab adjacent experience (can be analytical or micro).Knowledge of QMS (Veeva), CMMS (Maximo, Nuvolo), and LIMS .Bachelor's Degree in Lab Sciences, such as Chemistry, Biochemistry, Material Science, Immunology.Strong technical knowledge including an...
At Zelis, the Itemized Bill Review Facility Reviewer is responsible for analyzing facility inpatient and outpatient claims for Health Plans and ensuring adherence to proper billing guidelines. ...
We are seeking Medical Analysts with experience in preparing Medicare Set Asides and Medical Cost Projections.This includes reviewing records, preparing the narrative and an appropriate allocation for medical treatment and prescription medications.Candidates will demonstrate knowledge of CMS policie...
We are seeking Medical Analysts with experience in preparing Medicare Set Asides and Medical Cost Projections.This includes reviewing records, preparing the narrative and an appropriate allocation for medical treatment and prescription medications.Candidates will demonstrate knowledge of CMS policie...
The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines and rules, evidence based clinical criteria plan, and policy exclusions. ...
E'S with FDOT experience in design and analysis of stormwater management and drainage systems, flood studies, bridge hydraulics and scour countermeasures.This role will be a 50% split between time on review of FDOT access and drainage connection permits and 50% in a design role on highways, flood mi...