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. ...
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...
Purpose of the role: The Welocalize Lead Reviewer is responsible for the overall quality of their language at an account level. Reviews copy/loc and gives feedback to the linguists; communicates feedback received from 3rd party reviewers and Apple Language Leads. Responds to content reviewers' queri...
Position Overview: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. ...
We are seeking a detail-oriented Quality Control Data Reviewer to support our commitment to excellence in oncology data management. The Quality Control Data Reviewer in Technical Operation department will play a crucial role in ensuring the accuracy, reliability, and integrity of analytical data wit...
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 a detail-oriented Quality Control Data Reviewer to support our commitment to excellence in oncology data management. The Quality Control Data Reviewer in Technical Operation department will play a crucial role in ensuring the accuracy, reliability, and integrity of analytical data wit...
Maximus Federal is seeking an Optometrist to join the Medical Consultant panel as an Expert Medical Reviewer for Quality Management Reviews. ...
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...
As a trusted global transformation partner, Welocalize accelerates the global business journey by enabling brands and companies to reach, engage, and grow international audiences.Welocalize delivers multilingual content transformation services in translation, localization, and adaptation for over 25...
The Nurse Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS compliance standards in the area of service deci...
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. ...
The Third-Party Reviewer functions under the general supervision of the Workers Comp and Motor Vehicle Supervisor/Manager. ...
NECO has an exciting opportunity in our Commonwealth Clinic for a Patient Billing and Claims Reviewer. The Patient Billing and Claims Reviewer (On-Site) will be located at 930 Commonwealth Avenue in our Commonwealth clinic. Patient Billing and Claims Reviewer (On-Site) Responsibilities:. Patient Bil...
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. ...
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 Third-Party Reviewer functions under the general supervision of the HSN/ Other Government Unit Supervisor/Manager. ...
In this exciting position the content reviewer will localize, translate and adapt the content of various categories (i. ...
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. ...
In this exciting position the content reviewer will localize, translate and adapt the content of various categories (i. ...
Travel Expenses Reviewer - hybrid - $25/hr. We’re looking for adetail-oriented Travel Expenses Reviewer to join a supportive, collaborativeteam at a prestigious university. ...
The Third Party Reviewer functions under the general supervision of the payer unit Supervisor. ...
The Nurse Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS compliance standards in the area of service deci...
Within the Finance Department, the Financial Review is a dedicated and independent function in charge of permanent controls on accounting and financial information.The Financial Review is a key component of the Enterprise Risk Management framework.As part of the second line of defense, it consists o...