Remote Nurse Specialist II, Medical Claims & Compliance
$57.51k - $85.84kQlarant
- Remote job
Qlarant is seeking a Nurse Specialist II to perform medical record and claims review for Medicare, Medicaid, and other claims data, ensuring guidelines are followed and identifying potential overpayment, fraud, waste, and abuse. The role requires a minimum Bachelor's Degree and 2–4 years of experience (5–7 years preferred); RN licensure is required and coding certification preferred. Remote work options are available; salary ranges from $57,512 to $85,839 annually. #J-18808-Ljbffr Qlarant
$60.78k
...Appeals and Grievances Specialist II Job Category:... ...resolution of complaints in compliance with Centers for... ...(DMHC), Managed Risk Medical Insurance Board (MBMIB... ...and complex provider claim disputes. The position... ...weekends, holidays, a hybrid remote schedule, occasional flexibility...Remote workMedicalClaimsFull timeLocal areaShift workWeekend work- ...Credentialing & Enrollment Specialist IIto join our... ...Specialist II : Provider Lifecycle... ...enrollment-related claim denial triage Assist... ...billing issues Compliance Execution Gather audit... ...health care (medical, dental, vision) Pet... ...and sick leave Work remotely and whatever...Remote workMedicalClaimsTemporary work
$52.69 - $69.82 per hour
...- 08 Hour R2658919 Remote USA 108610021 Admin Compliance Business & Administration... ...APC assignments, medical necessity, and... ...Compliance Auditor II is the full proficiency... ...billing errors before claims submission, ensuring... ...- Certified Coding Specialist required within 180...Remote jobMedicalClaimsHourly payFull timeWork experience placementWork at office- ## Program Coordinator II - Compliance OfficerApplylocations: Wake County,... ...compensation injury reports and claims filed annually under the Act.... ...receive disability and medical benefits as ordered by the Industrial... ...with routine office and remote workdays. The posting will close...Remote workMedicalClaimsContract workWork experience placementWork at officeFlexible hoursNight shift
$63.65k - $92.57k
...professionals, including doctors, nurses, business people, tech... ...drive groundbreaking medical discoveries and invite... ...Actuarial Analyst II position will serve as... ...reporting to monitor claims and risk score trends,... ...Working Conditions This is a remote role that can be done...Remote workMedicalClaimsFull timeWork at officeMonday to FridayFlexible hoursShift work$34.76k
...Working Title: REGULATORY SPECIALIST II - 64080600 Pay Plan:... ...Division of Medical Quality Assurance Bureau... ...positions who ensure compliance with regulations or rules... ...regular telework or remote option. The Benefits... .... Candidates claiming Veterans’ Preference must...Remote workMedicalClaimsWork at officeImmediate startFlexible hours$70k - $85k
...As a Business Analyst II, you'll partner with clients... ...outcomes. This is a remote-first role that may... ...healthcare data (e.g., claims, EMR, HEOR, SDOH) Proficient... ...with about 5% travel Medical, dental, vision, life,... ...Office of Federal Contract Compliance Programs (OFCCP)...Remote jobMedicalClaimsContract workFor contractorsFor subcontractorWork at officeFlexible hours$70k - $85k
...Risk Adjustment Coding Specialist. This role will report... ...diagnostic data from medical records to verify that... ...monitor, and document claims and encounter coding information... ...coding regulations, compliance guidelines, and... ...75% travel) with remote support to help practices...Remote workMedicalClaimsWork at officeWork from homeHome office- ...UT Southwestern Medical Center is hiring a Technical Denials Management Specialist II within the Revenue Cycle Department. The role focuses on reviewing, researching and resolving claim denials and appeals across payors to maximize collections. The candidate should have...Remote workMedicalClaimsLocal areaWork from home
$32.18 - $48.68 per hour
...treatment, certifies the medical necessity and assigns... ...of CorVel. This is a remote position. ESSENTIAL... ...concern to the appropriate claims staff/customer... ...of accredited school of nursing with an associate’s degree... ...For leveled roles (I, II, III, Senior, Lead, etc...Remote workMedicalClaimsHourly payMinimum wageFull timeWork at officeLocal areaFlexible hours- ...Performance is searching for a Follow Up Specialist II to join their remote team. The ideal candidate will be... ...up on outstanding insurance claims, ensuring prompt reimbursement while... ...resolve issues. A strong background in medical billing and knowledge of healthcare...Remote jobMedicalClaims
$77.12k - $138.81k
...spouses. USAA roles may offer remote or hybrid flexibility for... ...and manage business risks in compliance with internal risk management... ...background in trend analysis, claims analytics, and reserving.... ...benefits include comprehensive medical, dental and vision plans, 401...Remote workMedicalClaimsFull timeH1bWork at officeRelocation packageFlexible hours- ...Coding Specialist II Join our team as a Coding Specialist II. Are... ...about ensuring accuracy in medical coding and billing? We're looking... ...compliant and timely claim submission. You'll also provide... ...help ensure coding and billing compliance across the organization....Remote workMedicalClaims
- ...Performance in the United States is seeking a Medical Billing Specialist II who can accurately prepare and submit medical claims, verify CPT/ICD-10 codes and patient... ...rejections to support timely reimbursement. This remote, nationwide role requires 2+ years of medical...Remote workMedicalClaims
- ...Performance in the United States is seeking a Follow Up Specialist II to manage timely follow-up on outstanding insurance claims and ensure accurate reimbursement. You will... ...and clinical staff to resolve issues. This remote, nationwide position requires strong...Remote jobMedicalClaims
$69.3k - $78k
...healthcare payment integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and Commercial Payers.... ...auditing claims and documenting findings, all in a remote work environment. This role offers a...Remote jobMedicalClaims- Signature Performance is seeking a Follow Up Specialist II to manage timely follow-up on insurance claims and ensure accurate reimbursement. You will analyze account... ...resolve issues. The role requires experience in medical billing or revenue cycle operations, proficiency...Remote jobMedicalClaims
- The Clinical Review Nurse II role at Elevance Health is designed for experienced... ...to review and render complex medical determinations for benefits eligibility on member claims. Candidates should have an RN... ...review processes. This hybrid/remote position includes in-person...Remote jobMedicalClaims
- ...Systems Analyst II Rising Medical Solutions has an opening for a Systems Analyst II, and we want to hear from you! We're a bill review and... ...broken healthcare system by reducing the cost of healthcare claims through bill review, case management, and utilization review...Remote workMedicalClaims
- Machinify is a leading healthcare intelligence company. The Medical Review Nurse II audits home health claims, working remotely with a multi-location team to ensure compliance and high-quality documentation. The role emphasizes strong clinical judgment, coding accuracy,...Remote jobMedicalClaimsWork from home
- ...hiring an Inside Adjuster Consultant II- DSM to investigate complex claims, including UM/UIM, and to negotiate settlements. You will review medical reports, take statements, and coordinate... ...thorough documentation and compliance. The role emphasizes strong analytical...Remote jobMedicalClaims
- ...Title - Medical Coder II, Certified Shift - (Remote working after on-site training (2-4 weeks). Must be located in the Portland, OR Metro Area. Flexible... .... This position will ensure accurate coding and claim submission and conformity to applicable guidelines and...Remote workMedicalClaimsPermanent employmentFlexible hoursShift work
$55k - $60k
Aon plc in the United States is seeking a Claims Specialist II to adjudicate travel insurance claims and... ...virtual training followed by hybrid or remote work options. You will review submissions, verify coverage, examine medical records, and make determinations while maintaining...Remote jobMedicalClaims- Signature Performance is seeking a Medical Billing Specialist II for a remote, nationwide role. You will prepare and submit medical claims, verify CPT/ICD-10 details, and ensure billing... ...position supports AR follow-up and compliance with HIPAA, with growth opportunities...Remote jobMedicalClaims
- CareFirst BlueCross BlueShield in Baltimore, MD, seeks a Claims Recovery Specialist II to review and audit medical and dental claims to recover overpayments and maximize recoveries. This role supports refunds of payments made in error and works with claims, service, finance...Remote jobMedicalClaims
- ...BlueCross BlueShield South Carolina subsidiary, seeks a Medical Reviewer II (RN) to perform medical claim reviews and determine medical necessity using... ...utilization review across multiple services. The position is remote, full-time, with standard hours 8:00 AM-5:00 PM ET,...Remote jobMedicalClaimsFull time
- ...discrimination and harassment claims, wage and hour issues, disability... ..., leave laws, and compliance with federal and state employment... ...to operate. Appointment to the II level requires that the incumbent... ...employment history verification, medical evaluation, confirmation of...Remote workMedicalClaimsWork at officeFlexible hours
- EMPLOYERS is seeking a Senior Work Comp Claims Adjuster II for a 100% remote opportunity across the United States. The role handles high or catastrophic... ...include data integrity, independent case analysis, medical treatment coordination, collaboration with defense counsel...Remote jobMedicalClaims
- Signature Performance is seeking a Medical Billing Specialist II for a remote-based role open to applicants nationwide. The position... ...You will review, submit, and follow up on claims, ensure coding accuracy, and maintain compliance with HIPAA and payer guidelines. The role...Remote jobMedicalClaims
- ...workers' compensation indemnity claims, the full-time Workers Compensation Claims Examiner II will assist in the... ...to conclusion, while working remotely in compliance with established policies and... ...Communicates with claimants, medical providers, and legal counsel...Remote workMedicalClaimsFull time
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