Medical Necessity & Denials Compliance Specialist
Duke Clinical Research Institute
Duke Health in Durham, NC is seeking a Compliance Specialist focused on Medical Necessity and Authorization Denials. The role supports quality audits of internal and vendor denial reviews and assists with onboarding, training, and education activities within the PRMO Internal Controls framework. The position splits time between Quality Audit (80%) and Special Projects (20%), requiring coding knowledge, strong communication, and detail‑oriented analysis to ensure accurate reviews and adherence to #J-18808-Ljbffr Duke Clinical Research Institute
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Medical Necessity & Denials Compliance Specialist in Durham, NC vacancy
€58.5k - €89.25k per year
...who give possibilities purpose. BD is one of the largest global medical technology companies in the world. Advancing the world of... ...development and product lifecycle activities. Support CE marking and compliance with applicable EU machinery legislation, including the...MedicalHourly payWorldwideShift work- ...for major purchases and day-to-day essentials! * Competitive Medical, Vision, Dental, company funded Life Insurance, FSA/DCFSA, and... ...multi-point Inspection of automotive vehicles to ensure compliance to emission standards and governmental regulations and maintain...MedicalFull timeTemporary workLocal areaFlexible hours
Jiffy Lube
Durham, NC14 hours ago $60k - $70k
...seeking a motivated and detail-oriented Full Time - Grant Compliance & Monitoring Specialist to join our team. In this role, you will play a critical... ...origin, ancestry, age, physical or mental disability, medical condition, genetic information, pregnancy (including childbirth...MedicalFull timeWork at officeWork from home$108.5k - $201.5k
...job title: Sr. Spec. DDIT ISC OperationsAbout the Role:The GRC Compliance Senior Analyst and support information security, risk, and... ...accommodation to individuals with disabilities. If, because of a medical condition or disability, you need a reasonable accommodation for...MedicalFull time3 days per weekNovartis
Durham, NC3 days ago- ...defined by the scope of assignment, and assist staff in improving compliance with relevant International Conference on Harmonization (ICH),... ..., training, and experience.Sound working knowledge of medical terminology, Standard Operating Procedures (SOPs), International...MedicalFull timeWork at office
$19.8 - $22.9 per hour
...any other protected category. Sephora is committed to providing reasonable accommodation to applicants with disabilities or other medical conditions.Sephora will consider all qualified applicants, including those with arrest and conviction records, in a manner consistent...MedicalHourly payPart timeShift workNight shiftWeekend workSephora
Durham, NC3 days ago$49.94k - $79.49k
Occupational Summary Lead and manage compliance and reporting activities associated with grant-supported intellectual property, including... ...on your paycheck. Duke provides comprehensive and competitive medical and dental care programs, generous retirement benefits, and a...MedicalWork experience placementWork at office$103.6k - $288.6k
...sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at IQVIA is proud to be an equal...MedicalFull timePart timeWork at officeImmediate startWorldwideFlexible hoursIQVIA
Durham, NC3 days ago- ...Jiffy Lube / Premium Velocity Auto Is Hiring for an Advanced Specialist! Accelerate Your Automotive Career with a High‑Performance... ...Full‑Time Employee Benefits Employer/employee‑funded medical, dental, vision, and prescription coverage Company‑funded life...MedicalFull timeLocal areaFlexible hoursShift work
Premium Velocity Auto LLC
Chapel Hill, NC4 days ago $33.37 - $47.97 per hour
...communities we serve across North Carolina. Summary The HCS Compliance Analyst III will be assigned to support one (1) of the following... ...of healthcare reimbursement, health system operations, medical staff standards, coding, billing, and documentation, along with...MedicalHourly payFull time- Freudenberg Sealing Technologies S.a.s. di Externa Italia S.r.l.u. in Durham, NC seeks a compliance professional to implement and improve internal control programs and manage import/export compliance within SAP and related systems. You will assess risks, coordinate corrective...
- ...Job Description Job Description Position Overview TRC Talent Solutions client is seeking a detail-oriented DEA Compliance Specialist to support the controlled substance compliance program for a pharmaceutical distribution organization in Durham, NC. This position...Weekend workAfternoon shift
TRC Talent Solutions
Durham, NC1 day ago - Arabella Advisors is seeking an HR Compliance Associate to work on a collaborative, client-facing team responsible for maintaining personnel compliance. The role involves hiring and worker classification processes, plus contributing to risk assessment and audit programs...
- Duke Clinical Research Institute seeks a proactive Compliance Lead to manage grant-supported IP and reporting obligations. You will oversee iEdison submissions, Bayh-Dole coordination, and sponsor reporting, ensuring data integrity across systems and audit-ready records...
- ...Metric Bio are supporting a Leading CDMO in their search for an on-site Senior Validation Specialist for their Morrisville, North Carolina Facility. You will be responsible for Pharmaceutical Validation of Equipment and GxP computerized systems whilst having oversight...
Metric Bio
Morrisville, NC15 days ago - Bank of America is seeking a Financial Solutions Advisor Stage I (FSA I) to begin by obtaining securities licenses (SIE, Series 7, Series 66) and to learn foundational skills for advising clients on banking and investment solutions. The role progresses to a Financial Solutions...
$26.41 - $51.49 per hour
...community resources to enhance continuity of care. Assesses for medical necessity and authorizes all appropriate waiver services. Evaluates... ...interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. Uses motivational...MedicalHourly payWork experience placementWork at officeLocal area- ACA Group is seeking a compliance professional to administer client relationships and support regulatory consulting for investment advisory clients. The role collaborates with the Chief Compliance Officer to coordinate compliance program reviews and develop reports, policies...Remote work
- Accentuate Staffing is seeking an experienced HR professional to support a temporary project focused on reviewing and reconciling employee Form I-9 records. The role involves handling records across paper files and Workday, verifying eligibility, and confirming E-Verify...Temporary work
- ...and payors. The role focuses on payor credentialization, credentialing with PECOS, NPPES, and state licenses, and ensuring timely compliance to meet organizational goals. You will collaborate with operations and clinical teams, maintain contract trackers, and help...Contract work
- IEM seeks a motivated Full Time Grant Compliance & Monitoring Specialist to join our team. You will review program documentation for accuracy and compliance, and support day-to-day project management activities related to grant compliance and monitoring. The ideal candidate...Remote jobFull time
- HR Compliance Associate, Managed Organizations (AA) Arabella Advisors helps foundations, philanthropists and investors who are serious about impact achieve the greatest good with their resources. We work on issues ranging from the social and economic advancement of women...
- ...Summary The Episodic Care Manager is responsible for performing medical reviews to assess, facilitate, and coordinate the delivery of... ...quality, cost effective health care services based on medical necessity and contractual benefits. In addition, the Episodic Care Manager...Medical
- ...#CloroxIsThePlaceYour role at Clorox:The Regulatory Affairs Specialist II supports regulatory compliance and product safety for Clorox’s FDA-regulated Foods... ...NOTE: This is not a role for someone with a pharma or medical device background.In this role, you will:Provide...Full timeSummer workWork at officeRemote workFlexible hours3 days per week
The Clorox Company
Durham, NC4 days ago - ...Manager in Durham, North Carolina. In this role, you will perform medical reviews to assess and coordinate the delivery of care within... ...quality, cost-effective health care services based on medical necessity. Collaboration with providers and consumers is essential to deliver...MedicalContract work
- ...Duke Health's four hospitals and offers a comprehensive range of medical, surgical, and diagnostic services, including orthopedics,... ...appropriately. Discharge patient when goals have been met or medical necessity is no longer warrants intervention. Establish provisions for...MedicalTemporary work
Duke University
Durham, NC14 hours ago $1,346 per week
...: 13 Weeks Start Date: ASAP About the Position We are currently seeking qualified candidates for PTA Position Details: Location Durham, NC Shift 5x8 Days Duration of Assignment 91 Day 1 Medical, Health, Dental, Vision. $500 Referral Bonus...MedicalFull timeContract workImmediate startShift workLancesoft Inc.
Durham, NC1 day ago$1,884 per week
...Duration: 14 Weeks Start Date: ASAP About the Position We are currently seeking qualified candidates for OT Position Details: Location Durham, NC Shift 5x8 Days Duration of Assignment 98 Day 1 Medical, Health, Dental, Vision. $500 Referral Bonus...MedicalFull timeContract workImmediate startShift workLancesoft Inc.
Durham, NC1 day ago$1,713 per week
...Duration: 13 Weeks Start Date: ASAP About the Position We are currently seeking qualified candidates for PT Position Details: Location Durham, NC Shift 5x8 Days Duration of Assignment 91 Day 1 Medical, Health, Dental, Vision. $500 Referral Bonus...MedicalFull timeContract workImmediate startShift workLancesoft Inc.
Durham, NC1 day ago$2,181 per week
...CT Tech Location: Durham, NC Agency: Coast Medical Service Pay: $2,181 per week Shift Information: Nights - 3 days x 12 hours Contract Duration: 13 Weeks Start Date: 12/14/2026 About the Position Coast Medical Service is a nationwide...MedicalFull timeContract workShift workNight shiftCoast Medical Service
Durham, NC1 day ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Medical Necessity & Denials Compliance Specialist. Be the first to apply!
Related searches
- hca hospital Durham, NC
- health care assistant hospital Durham, NC
- clinical support assistant Durham, NC
- pct Durham, NC
- patient care technician pct Durham, NC
- health care worker Durham, NC
- medical records specialist Durham, NC
- medical specialist Durham, NC
- healthcare support worker Durham, NC
- medical management specialist Durham, NC