Remote Nurse Reviewer - Medical Claims & Fraud Prevention
Peraton
- Remote job
SafeGuard Services (SGS), a Peraton subsidiary, seeks a Nurse Reviewer to join a team of professionals. The role involves medical record reviews, applying clinical judgment to claim payments, and developing fraud investigations. Telework is available from anywhere in the United States. The position emphasizes adherence to federal and state regulations, strong communication, and independent work within a collaborative team. Qualified nurses with experience in claims review are encouraged to apply. #J-18808-Ljbffr Peraton
$51k - $82k
...data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse. We are looking to add a Nurse Reviewer to our SGS team of... ...apply sound clinical judgment to claim payment decisions....Remote workMedicalClaimsFraudContract workTemporary workShift workNight shift$77.78k - $105.23k
GDIT’s Federal Health Division seeks a remote healthcare coding expert to support the Centers... ...and Medicaid Services. The role reviews claims data to spot trends and builds leads and referrals for the Healthcare Fraud Prevention Partnership. A certified professional coder...Remote jobMedicalClaimsFraudFull time- Peraton’s SafeGuard Services seeks a Nurse Reviewer to conduct medical record reviews, applying clinical judgment to claim payments and supporting fraud investigations. Telework is available from any state. The ideal candidate will hold a US nursing license, have 5+ years...Remote jobMedicalClaimsFraud
- Peraton is seeking a Nurse Reviewer to join SafeGuard Services (SGS) and conduct medical record reviews, applying clinical judgment to claim payments. The role supports fraud investigations and referrals, with opportunities to develop cases for law enforcement and recovery...Remote jobMedicalClaimsFraud
- ...better care.? Requirements The Nurse Reviewer performs complex medical record reviews of Medicare Part A/B and DMEPOS claims that require clinical... ...potential for overpayment or fraud. Using established criteria... ...essential functions. This is a remote position. While performing...Remote workMedicalClaimsFraudContract workFor contractorsLocal area
$64.23k - $86.25k
...Liaison (CMS Healthcare Fraud Prevention) based in the United... ...understanding of healthcare claims, health insurance... .... Comprehensive medical plan options,... ...opportunities. Fully remote work arrangement, available... ...your application is reviewed quickly, objectively,...Remote workMedicalClaimsFraudFull timeTemporary workWork at officeFlexible hours$64.23k - $86.25k
...Qualifications: Skills: Fraud Prevention, Health Claims, Health Insurance Claims,... ...data. This position is remote Work visa sponsorship will... ...includes a variety of medical plan options, some with Health... ...or available. We regularly review our Total Rewards package to...Remote workMedicalClaimsFraudFull timeTemporary workWork experience placementWork at officeImmediate startWorldwideFlexible hours- ...Physicians Service (WPS) is seeking a Claims Examiner III LPN/RN to safeguard MVH program... ...by identifying, investigating, and preventing fraud, waste, and abuse. The role blends clinical... ...with data analysis to evaluate medical necessity and ensure proper benefit administration...Remote jobMedicalClaimsFraud
- ForHealth Consulting at UMass Chan Medical School seeks an Auditor to identify, investigate, and prevent Medicaid fraud, waste and abuse. You will... ..., using data mining and claims analysis to detect irregular... ...per month; most work is remote with periodic site visits....Remote jobMedicalClaimsFraud
$150k - $240k
...is investing in our fraud detection and investigation... ..., AI-Enabled Fraud Prevention & Investigations to... ...turn millions of claim lines and/or medical record data into a prioritized... ...regular compensation reviews to recognize and... ..., we embrace a remote-first culture that supports...Remote jobMedicalClaimsFraudWork experience placementWork at officeFlexible hours- ...sees clients for preventative and acute care.... .... This is a remote opportunity.... ...technologists, nurses and managers)... ...best evidence medical care Collaborate... ...Candidates: Recruitment Fraud Please note... ...organization claiming to represent... ...decisions are reviewed and made by our...Remote workMedicalClaimsFraudFor contractorsWeekday work
$275k - $290k
Medical Director# Medical DirectorHot JobFully Remote • Windsor Mill, MD 21224; Windsor Mill, MD 21244## OverviewSalary... ...for contributing to fraud prevention providing clinical... ...insurance industry, a utilization review firm, or another health care claims processing organization in...Remote workMedicalClaimsFraudContract workFor contractorsLive in- ...detection, investigation and prevention of healthcare fraud, waste and abuse (FWA).... ...any findings from medical record reviews Knowledgeable in using... ...least 2 years of healthcare claims investigation experience... ...work independently within a remote team, under minimal supervision...Remote workMedicalClaimsFraud
- ...seeking a Risk & Fraud Analyst I to support... ...the Bank’s fraud prevention and risk management... ...and controls. Review and investigate daily... ...Support dispute and claims processes across... ...Up to 2 weeks of remote work to care for a... ...family member with medical needs. Wellhub membership...Remote workMedicalClaimsFraudTemporary workWork at officeLocal area
- ...the infrastructure that makes medical practices actually get paid.... ...Process medical billing claims accurately and efficiently using... ...to podiatric procedures. Review patient records to ensure... ...Knowledge of HIPAA compliance, fraud prevention, and audit readiness....Remote workMedicalClaimsFraudHourly payFull timeContract workFor contractorsWork at officeTrial period
- ...Description Healthcare Fraud Shield, a leader... ...healthcare fraud prevention and payment... ...SIU Team (Clinical Reviewers, CPCs, Investigators... ...interpret patient medical records (... ...submitted on the claims in order to determine... ...development initiatives ~ Remote work eligible...Remote workMedicalClaimsFraudFull timeFlexible hours
- ...and WI. This is a remote position.... ...manage insurance claims and oversee timely... ...billing data and medical claims to insurance... ...and payment through review and correction of... ...we support, and to prevent participation by individuals... ...excluded due to fraud, abuse, and other...Remote workMedicalClaimsFraudWork experience placementWork at office
- Registered Nurse - Clinical Documentation... ...: Hybrid Remote Assignment: 13-... ...Join CornerStone Medical! CornerStone... ...documentation review, and billing compliance... ...health claims and clinical documentation... ...potential fraud, waste, or... ...compliance and fraud prevention. #J-18808-...Remote workMedicalClaimsFraudContract workWork at officeMonday to Friday
$60 - $70 per hour
Position: Senior Fraud Operations SpecialistLocation... ...detect, mitigate, and prevent fraud and scam activity... ...onsite, Monday to Friday remote) 6 Infinite Loop... ...to benefits including medical, dental, vision and 401... ..., email, or phone call claiming to be from PTR Global do...Remote workMedicalClaimsFraudFull timeMonday to Friday$95k - $110k
...It takes great medical minds to create powerful solutions that solve... ...individual for a DRG Nurse Reviewer Appeals and Hearings to coordinate... ...perform reviews of multiple claim types to provide a flexible workforce... ...expect in this role Remote (Work from Home) Up to 25% Travel...Remote workMedicalClaimsFull timeWork from homeRelocation packageFlexible hours$95k - $110k
...It takes great medical minds to create powerful solutions that solve... ...individual for a DRG Nurse Reviewer Appeals and Hearings to coordinate... ...perform reviews of multiple claim types to provide a flexible workforce... ...expect in this role Remote (Work from Home) Up to 25%...Remote workMedicalClaimsFull timeWork from homeRelocation packageFlexible hours- ...Provide timely review and determination of medical claims, including prior authorization, appeals, and/or any other... ...State license as a Registered Nurse (RN),as required by contract(s). 1... ...attendance is essential for this position Remote Compensation details: 67500-75000...Remote workMedicalClaimsContract workFor contractorsWork experience placementWork at officeLocal area
$46.99k - $102k
...suspected acts of healthcare fraud and abuse. Routinely... ...schemes. Investigates to prevent payment of fraudulent claims submitted to the Medicaid... ...for clinical and legal review Documents all appropriate... ...~ Working knowledge of medical coding; CPT, HCPCS, ICD10...Remote workMedicalClaimsFraudHourly payFull timeWork at officeLocal area$110k - $140k
...an experienced Senior Claims Analyst with deep expertise... ...skills. This is a remote role. Key... ...Responsibilities Claims Analysis & Review ~ Perform detailed... ..., UB-04 claim forms, medical records, and remittance... ...Hospital/Surgical/ICU Nursing background (RN) and clinical...Remote workMedicalClaimsFull timeContract work$77.1k
...Affordable and comprehensive medical, dental and vision... ...The SIU Fraud Investigator is responsible... ...investigator analyzes claims, encounter, enrollment... ...Compliance Program and Fraud Prevention Program by mitigating... ...required. Knowledge of reviewing medical records/...Remote workMedicalClaimsFraudFull timePart timeWork at officeFlexible hours$63.44k - $95.16k
...incident-only, medical-only, and lost-... ...' Compensation claims across multiple... ...core location, 4 remote days). This... ...Program. Utilize nurse triage services... ...potential fraud indicators and... ...enhance injury prevention and improve claim... ...and evidence, reviewing medical records...Remote workMedicalClaimsFraudFull time- ...today and address the medical challenges of... ...Work development & review, deliverable oversight... ...analysis and risk prevention. Co-development... ...This is a remote position but must... ...Recruitment Fraud Alert AbbVie... ...or communication claiming to be from AbbVie,...Remote workMedicalClaimsFraudImmediate start
$64.83k - $94.55k
...aberrant behavior observed in claims and enrollment data.... ...improvements for Fraud Waste and Abuse (FWA) recoupments... ...This position is fully remote and open to candidates... ...“pay-and-chase” to preventive edits and prepayment... ...for benefits including: medical, dental, and vision...Remote workMedicalClaimsFraudFull timeWork from homeHome office$24 - $26 per hour
...This is a remote position. We're looking... ...researching denied claims, collaborating... ...initiatives. • Regularly reviews aging appeals and... ...revenue cycle and medical terminology. •... ...support, and to prevent participation by... ...are excluded due to fraud, abuse, or other...Remote workMedicalClaimsFraudHourly payContract workWork at office- ...Director or designee, the Fraud, Waste, and Abuse (... ...investigating, and preventing fraud, waste and... ...including data mining, claims analysis, and medical record assessment.... ...of the job are remote. Responsibilities... ...administrative medical record reviews or other claims...Remote workMedicalClaimsFraudWork at office
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