Utilization Review Nurse — Appeals & Medical Claims
$29.05 - $67.97 per hourMolina Healthcare of Illinois
Molina Healthcare in Boise, Idaho is seeking a skilled RN to review medical records and ensure accurate billing and claims processing. Candidates must have clinical nursing experience and an active RN license. The position involves medical reviews and direct interaction with healthcare professionals. The role contributes to the healthcare quality assurance process while offering a salary range of $29.05 - $67.97 hourly. Molina Healthcare is dedicated to providing equal employment opportunities. #J-18808-Ljbffr Molina Healthcare
Vacancy posted 22 hours ago
Similar jobs that could be interesting for youBased on the Utilization Review Nurse — Appeals & Medical Claims in Boise, ID vacancy
$29.05 - $67.97 per hour
...Description Job Summary Utilizing clinical knowledge... ..., responsible for review of documentation to ensure medical necessity and... ...medical record and claim submitted support correct... ...review of appeals for denied prior authorizations... ...2 years clinical nursing experience,...MedicalClaimsHourly payWork experience placementWork at officeMolina Healthcare
Boise, ID2 days ago$29.05 - $67.97 per hour
...Description Job Summary Utilizing clinical knowledge... ..., responsible for review of documentation to ensure medical necessity and... ...medical record and claim submitted support... ...concurrent review of appeals for denied prior... ...least 2 years clinical nursing experience,...MedicalClaimsHourly payWork experience placementWork at officeMolina Healthcare
Meridian, ID1 day ago- ...Clinical Appeals Reviewer (Licensed Healthcare Professional... ...limited to Registered Nurses (RN), Physical... ...Responsibilities Reviews medical records/case files,... ...Medicare regulations, claims processing, and the medical... ...care appeals or utilization management activities...MedicalClaimsFull timeContract workPart timeFor contractorsWork at officeLocal areaRemote workNight shift
St. George Tanaq Corporation
Boise, ID3 days ago $246.1k - $344.2k
...part of our caring community The Corporate Medical Director relies on medical background and reviews health claims. You will work on problems of diverse scope and... ...timely, and defensible medical decisions on complex appeal cases, exercising professional judgment with...MedicalClaimsBi-weekly payFull timeTemporary workApprenticeshipInterim roleWork at officeRemote workWork from homeHome officeMonday to FridayHumana
Boise, ID2 days ago- ...to detail, and accuracy to your work as a Medical Insurance Billing Specialist. You know... ...Prepare and submit accurate insurance claims to various payers Generate and send patient... ...and resolve discrepancies, denials, appeals, and collections Ability to maintain a...MedicalClaimsWork at officeFlexible hours
Primary Health Medical Group
Boise, ID2 days ago $24 - $27 per hour
...worth it. One in ten skilled nursing facility residents will develop... ...condition requiring expert medical care, and one in four patients... ...process and insurance claims processing cycle Claims Knowledge... ...claim data and submit written appeals with supporting documentation...MedicalClaimsHourly payFull timeCasual workWork at officeRemote workMonday to Friday$72.91k - $95k
...Financial Services & Insurance Claims Team Lead - Workers... ...claims adjudication. Compiles reviews and analyzes management reports... ...standards. Acts as second level of appeal for client and claimant issues... ...including but not limited to, medical, dental, vision, 401k and matching...MedicalClaimsContract workWork at officeLocal areaFlexible hoursSedgwick
Boise, ID22 hours ago- ...as prior authorization, step therapy, reviewing denied claims, and processing overrides. Works with... ...knowledge of high-cost specialty medications, the applicable pharmaceutical regulations... ..., and escalated prior authorization appeals. Will assist in preparing for and...MedicalClaims
St. Luke's Health System
Boise, ID4 days ago - ...professionalism and courtesy. - Utilizes knowledge of insurance... ...members in understanding how their medical claims were processed and how their... ..., educates members on their appeal rights, explaining the... ...how to submit an appeal, the review and decision-making process,...MedicalClaims
St. Luke's Health System
Boise, ID4 days ago - ...against all types of General Liability claims, including cases involving... ...mediation, arbitration, trial, and appeal, we provide comprehensive legal representation... ..., your role will involve: Reviewing and preparing summaries of medical records to effectively advocate for...MedicalClaimsInterim role
$25.02 - $39.41 per hour
...policies, as well as ensures claims meet medical necessity for procedures... .... Essential Functions Reviews and analyzes emergency department... ...discrepancies or errors. Utilizes appropriate tools, resources... ...responds to coding denials, appeals, and audits. Maintains...MedicalClaimsHourly payWork at officeShift workIntermountain Health
Boise, ID1 day ago$19.39 per hour
...center services. Serves as first line reviewer in monitoring and ensuring adherence... ...oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing... ...pharmacy representative in onsite member appeals and grievances sessions. Serve as...MedicalClaimsFor contractorsLocal areaHighmark Health
Boise, ID5 days ago- ...(ESOP). Our benefits, including top-tier medical plans and tuition support set us apart. In... ...invoices; reporting shortages and claims to ensure proper billing; breaking down loads... ...lift; etc. Maintains cleanliness and eye-appeal of work area, storage area, and selling...MedicalClaimsImmediate startShift workNight shift
WinCo Foods
Meridian, ID1 day ago $90k - $112.76k
...hospitals, health systems and medical groups. We are the one company... ...stages of the administrative appeals process. Every day, you will handle contract review and appeal template development... ...language and rates to resolve denied claims. Utilize payer-provider and...MedicalClaimsContract workLocal areaR1 RCM
Boise, ID3 days ago$18 - $22 per hour
...future. Our offerings include medical, dental, and vision coverage,... ...each payer contract and will utilize to ensure payments received... ...Works all denials and corrected claims collaborating with the biller... ...follow-up, payer contracts, appeals, self-pay billing, Medicare...MedicalClaimsContract workLive outWork at officeShift workSCA Health
Boise, ID22 hours ago- ...benefits, including top-tier medical plans and tuition support set... ...Maintains cleanliness and eye-appeal of work area, storage area,... ...clearly and professionally, utilizing excellent verbal, written and... ...authenticity of any communication claiming to be from WinCo by checking...MedicalClaimsImmediate startShift workNight shift
WinCo Foods
Eagle, ID1 day ago - ...Key Responsibilities: Review and process claims with a focus on accuracy and attention to detail Differentiate between claim forms... ...benefits (EOBs) and extract pertinent information Review medical records to identify and interpret key details that...MedicalClaims
Equiliem
Boise, ID3 days ago $20.02 - $25.78 per hour
...processes that healthcare providers utilize to capture, bill, and collect... ...Responsibilities Submitting medical documentation/billing data to insurance... ...providers Researching and appealing denied and rejected claims Preparing, reviewing, and transmitting claims using...MedicalClaimsHourly payTemporary workWork experience placementLocal areaImmediate startRemote workFlexible hoursCardinal Health
Boise, ID22 hours ago- ...customers regarding benefit clarifications, claim status and resolution, and general... ...accurate and timely manner. Prepare inbound appeals for review. Recommend and actively participate in... ...plan for eligible staff, including: Medical, dental, and vision 401K with up to 6%...MedicalClaimsContract workCasual workWork at office
- ...government regulations. PRIMARY RESPONSIBILITIES: Prepares and submits claims to various insurance companies electronically or on paper.... ...our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have...MedicalClaims
St. Luke
Boise, ID3 days ago $27.02 per hour
...analyzes Individual and/or Group medical risk factors for new... ...characteristics of employee groups, or past claim experience to determine what... ...level medical underwriting appeals and applicable clinical... ...case/care management or provider review. The incumbent must communicate...MedicalClaimsFor contractorsWork at officeLocal areaHighmark Health
Boise, ID1 day ago- ...Sedgwick in Boise, Idaho is seeking a Claims Adjuster for Workers Comp to manage workers' compensation claims, ensuring compensability... ...offers a flexible schedule and a comprehensive benefits package including medical, dental, and 401(k) from day one. #J-18808-Ljbffr...MedicalClaimsFlexible hours
Sedgwick
Boise, ID3 days ago - ...Vice President, Claims & Payment Integrity Operations The Vice... ...(CPC), Certified Professional Medical Auditor (CPMA), Certified Claims... ...Experience with AI/ML-powered claims review technologies and predictive... ...scenarios. Partner with Appeals & Grievances on claims-related...MedicalClaimsContract workFor contractorsWork experience placement
Blue Cross of Idaho
Meridian, ID22 hours ago - ...Revascent is seeking an experienced RCM Biller to join their team in Meridian, ID. The role involves preparing, reviewing, and submitting medical claims to ensure timely reimbursement and compliance with payer guidelines. Candidates should have 1–3 years of medical billing...MedicalClaimsRemote workFlexible hours
Revascent
Meridian, ID12 hours ago $46.66k - $72.25k
...performance of hospitals, health systems and medical groups. We are the one company that... ...orchestration. As our Supervisor, Complex Claims (Revenue Cycle Operations), you will help... ..., preferably in complex claims, billing, appeals, or collections 1+ year of lead, acting supervisor...MedicalClaimsLocal area$63.4k - $85k
...A leading claims management company is seeking a Claims Examiner to analyze workers compensation... ...remotely. The ideal candidate will utilize their 5 years of claims management... ..., along with generous benefits including medical, dental, vision, and 401K plans. #J-18808...MedicalClaimsRemote workFlexible hoursSedgwick
Boise, ID3 days ago$70.9k - $76.9k
Ryder System, Inc. is seeking an experienced claims professional in Boise, Idaho, to manage Auto Liability claims within a self-insured... ...competitive salary ranges from $70,900 to $76,900, along with comprehensive benefits including medical and 401(k). #J-18808-LjbffrMedicalClaimsRyder
Boise, ID2 days ago- ...supervision of the Clerical Pool Supervisor providing support to the claims staff for all centralized tasks accurately and timely. The... .... Receive and distribute faxes to claim files Pay non-medical invoices within 30 days of receipt. Mail form letters including...MedicalClaimsWork at office
Trean Corporation
Boise, ID1 day ago - ...Great West Casualty Company is seeking a Cargo Claims Adjuster to join their team, located in Boise, ID, or any of their five office... ...compensation, generous paid time off, and extensive benefits including medical, dental, and wellness programs. Become part of a company...MedicalClaimsWork at office
Great West Casualty Company
Boise, ID3 days ago $24 - $27 per hour
...United Wound Healing is seeking a full-time medical billing professional to work remotely or in-office, focused on resolving claims and managing accounts receivable. Candidates should have over 3 years of relevant experience and strong analytical skills. Responsibilities...MedicalClaimsHourly payFull timeWork at officeRemote workUnited Wound Healing
Boise, ID11 hours ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Review Nurse — Appeals & Medical Claims. Be the first to apply!
Related searches
- remote utilization review nurse part time Boise, ID
- medical screener reception technician Boise, ID
- medical office Boise, ID
- non emergency medical transportation Boise, ID
- medical internship Boise, ID
- medical temp Boise, ID
- medical writing Boise, ID
- work from home medical Boise, ID
- medical customer service representative Boise, ID
- medical office part time Boise, ID