Medicare Claims Review RN — CERT & Coding Expert
Catapult Consultants, LLC
Catapult Consultants, LLC is seeking a Registered Nurse to support the Medicare Comprehensive Error Rate Testing (CERT) program. This role involves reviewing claim documentation and medical records to assess payment qualifications and compliance with Medicare guidelines. The ideal candidate will have an active RN license, significant experience in coding and Medicare reimbursement, and familiarity with standard coding conventions. This full-time position is Monday to Friday. Catapult Consultants values diversity and does not discriminate in employment opportunities. #J-18808-Ljbffr Catapult Consultants, LLC
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...purchase orders and receiving documents. Processes and reviews accounts payable transactions for proper coding and approvals. Reconciles vendor statements and... ...Manager. Processes weekly check disbursements for claims and accounts payable. Follows up with department heads...Claims$24.03 - $30.91 per hour
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$70 - $110 per hour
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$200k - $235k
...management and clinical review functions, including... ...organization’s subject matter expert on utilization... ...dollar SMBs, disputed SMBs, coding-related clinical... ...such as MCG, InterQual, Medicare guidelines, plan guidelines... ...interpret utilization trends, claims data, clinical review...ClaimsFull time- 6AM City, LLC in California is seeking a Supervisor, EDI Claims to oversee the daily operations of the EDI Claims team. You will manage the processing of electronic claims and ensure compliance with established guidelines while developing effective solutions to meet regulatory...Claims
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- ...audit and budgeting process. This position reviews, reconciles, and analyzes data to ensure... ...and summary reports monthly Run paid claims reports monthly and/or quarterly to calculate... ...of CPT, HCPC, DRG, ICD-9, ICD-10 and NDC coding is a plus. Working Conditions and...ClaimsWork at office
$27 - $35 per hour
...ensuring accurate, compliant, and complete coding of professional outpatient encounters in... ...urgent care environment. This role reviews provider documentation, validates and corrects... ...or unclear documentation, and ensures all claims meet CCI, payer, and outpatient coding...ClaimsHourly payFull timeWork at officeRemote work- UCLA Health in California is seeking a qualified nurse for Oncology Practice. Candidates must possess an MSN/BSN and a valid California RN license, along with experience in patient care and infusion therapy. The role includes providing direct care, patient assessment, and...
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- ...A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to... ...in the field of claims adjusting. Our expert instructor, with years of industry experience... ...and view our 375+ Five-Star Google Reviews. You can also find us on YouTube at: (...ClaimsFlexible hours
$27.69 per hour
Claims Representative (IAP) Workers Compensation Training Program | California Are you looking... .... Documenting claims files and properly coding claim activity. Preparing detailed... ...virtual and/or in-person meetings, claim reviews and business functions as needed for educational...ClaimsWork at officeFlexible hours- ...Description Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Qualifications Nursing school graduate. California Registered Nurse License upon hire. 3 years...Work at office
$26.41 - $51.49 per hour
...Florida Job Summary: Provides support for clinical member services review assessment processes. Responsible for verifying that services are... ...of relevant education and experience. Registered Nurse (RN). License must be active and unrestricted in state of practice....Hourly payWork experience placementWork at officeRemote work$174.07k - $374.92k
...of control gaps in Policies, Procedures, Claims edits etc., and assists in seeking appropriate... ...prepares cases for clinical and legal review. Documents all appropriate information... ...care industry / knowledge of CPT and HCPCS coding guidelines and principles. Psychiatric...ClaimsFull timeLocal areaRemote workWork from home$180.5k - $236.91k
...Insurance (Payment Integrity) Every dollar Oscar pays on a claim that contains a billing error, a coding mistake, or fraud is a dollar that doesn't go toward... ...recovery workflows - with LLM‑powered medical record review, anomaly detection, and agentic workflows that...ClaimsFull timeWork at officeFlexible hoursShift work- ...data: eligibility files, claims, enrollment lists,... ...management of risk adjustment, coding integrity, and quality... ...initiatives, chart reviews, and audit activities to... ...preferred. LVN or RN preferred. Minimum 5-7... ...Working knowledge of Medicare Advantage, Medi‑Cal, risk...ClaimsWork at office
$100k - $105k
Claims Team Lead - Workers Compensation (HYBRID - West Hills, CA) page... ...’s broad, global network of experts to both learn from and to... ...adjudication, including quality reviews and reserve evaluations for high... ...needed.* Ensures accurate claim coding and documentation by examiners...ClaimsWork at officeLocal areaFlexible hours
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