Job Description
Job Title: Medical Claims Reviewer
Pay: $26-30/hour - Contract to Hire
Location: Remote
Shift: First (Monday-Friday 8 AM-5 PM)
Position Overview:
We are looking for a skilled and detail-focused Medical Claims Reviewer to perform comprehensive reviews of medical, surgical, and behavioral health claims for inpatient and outpatient services. This role involves using your clinical expertise, coding proficiency, and claims processing knowledge to assess and approve claims accurately and efficiently. You will ensure claims are aligned with program benefits and assist various stakeholders by providing coding-related insights and resolving inquiries related to claims processes.
Primary Responsibilities:
Review and evaluate medical, surgical, and behavioral health claims retrospectively for both inpatient and outpatient care.
Utilize clinical knowledge and coding standards to validate claims and ensure accurate processing.
Gather and prepare the necessary documentation for case payments and approvals.
Verify adherence to program guidelines, benefits, and authorizations.
Collaborate with medical directors, peer reviewers, Claims Administration, and other departments to share relevant clinical and coding information.
Act as a resource for staff on coding and claims-related questions.
Qualifications:
High School Diploma or GED (Required).
At least 2 years of experience reviewing medical claims.
Comprehensive understanding of medical and institutional claims workflows.
Strong grasp of medical coding practices and claims evaluation processes.
High attention to detail with strong analytical and critical-thinking skills.
Effective communication skills and the ability to work across teams.
Proficiency in claims review software and related tools.
...Comprehensive benefit package, including 403(b) retirement plan Paid malpractice, including employer-paid tail coverage Internal moonlighting available Family Friendly community with lots of kid-focused activities. Moderate climiate with 4 distinct seasons, large...
TotalMed Staffing is seeking a travel nurse RN Clinical Document Improvement Specialist for a travel nursing job in Anchorage, Alaska. Job Description & Requirements ~ Specialty: Clinical Document Improvement Specialist ~ Discipline: RN ~ Start Date: 03/10/2...
...people who make extraordinary contributions to the work we do. Job Summary As a member of the Art/Design Department, the Medical Illustrator I (MI I) is the ProdDev expert responsible for creating complex medical illustrations. They have familiarity with the...
...open your home to an adult with developmental disabilities. Shared living is an alternative to a 24-hour group home for adults... ...Massachusetts Department of Developmental Services (DDS). Shared Living providers welcome an individual into their stable and caring home...
...Role Description This is a part-time or full-time remote opportunity for a Remote Travel Advisor. The Remote Travel Advisor will be responsible for assisting clients with travel arrangements, providing recommendations on destinations, booking flights, accommodations...