Senior Hospital Claims Quality Reviewer
1199seiu
1199SEIU in New York is seeking an experienced Hospital Claims Processor to cross-train staff and support the Fraud & Abuse findings in the Hospital Claims Department. You will review complex claims and ensure timely processing across multiple programs. The role requires strong Excel skills, excellent written and verbal communication, and the ability to work under strict timelines. Collaboration with QA and management is essential. #J-18808-Ljbffr 1199seiu
- ...TitleResponsibilities• Monitor claims processing system (QNXT) to ensure functionality of hospital claims processing (i.e electronic... ..., system enhancements and review performance of automated software... ...received and reported by the Claims Quality Assurance Department• Resolve...QualityClaims
- ...experienced DRG Clinical Physician Reviewer to join our growing clinical... ..., you will review complex hospital cases to ensure accurate DRG... ...directly impact healthcare quality and reimbursement integrity.... ...with DRG Validation, CDI, or claims review strongly preferred ~...QualityClaimsRemote work
- .... Our agentic AI works claims end-to-end, from portal... ...We're looking for a Senior Accounts Receivable Specialist... ...Conduct QA reviews of permanent BA work during... ...the transition and flag quality gaps before the team exits... ...experience working in a hospital system or physician...QualitySeniorClaimsPermanent employmentFull timeWork at officeImmediate startFlexible hours
- ...founded in 2020 by experts in health tech, hospital systems, academia, and clinical AI. We... ...raising the bar for patient safety and data quality. Tomorrow, we will be the place where any... ...(e.g., 100% of the EMR, including some claims) Unstructured text (e.g., clinical notes,...QualitySeniorClaimsRemote workFlexible hours
$140k - $160k
...Clinical Risk ManagerThe Senior Clinical Risk Manager... ...promote patient safety, quality of care, and minimize... ...Management staff on how best to review risk management data,... ...: reporting potential claims as well as cases of... ...regulatory compliance: Hospital Safety Committee;...QualitySeniorClaimsTraineeshipLocal area$95k - $110k
...Senior Data AnalystUnited Hospital Fund (UHF) is dedicated to creating an effective and... ...by bridging and advancing quality and equity and supporting... ...infrastructure that translates complex claims and HRSN data into... ...Governance: Perform code reviews and implement rigorous...QualitySeniorClaims$183.85k - $289.99k
DescriptionThe Senior Director of Enterprise Data Partners (EDP)... ...data assets, including EMR, claims, and benchmarking data, enabling... ..., and strengthening data quality and trust in partnership with... ...academic health system or teaching hospital.Demonstrated success managing...QualitySeniorClaimsTraineeshipLocal area$130k - $160k
...Time Days (Hybrid)The Senior Revenue Accountant for... ...recognition, and reporting of hospital revenue, which... ...compliance, including reviewing hospital contracts to... ...Support investigation into claims patterns, payor mix... ...and deliver quality outcomes.Ability to develop...QualitySeniorClaimsFull timeTraineeshipWork at officeLocal area$183.85k - $289.99k
DescriptionThe Senior Director of Epic Revenue Cycle Applications is responsible... ...such as Cadence/Prelude, Resolute Hospital and Professional Billing, Claims, and related applications for both... ..., ensuring the delivery of high-quality support, upgrades, and system enhancements...QualitySeniorClaimsFull timeContract workTraineeshipLocal areaRemote work$24 - $43 per hour
Senior Inpatient Medical Coder/Acute Edits And Denials Claims Analyst Optum is a global organization that... ...that all Inpatient acute hospital coding assignments are... ...Operations Manager or Quality Management personnel.... ...payer and compliance reviews Other duties as assigned...QualitySeniorClaimsHourly payMinimum wageFull timeWork experience placementLocal areaRemote work$153.72k - $245k
...Compliance & PerformanceThe Senior Director, Contract... ...health system, including hospital, ambulatory, physician,... ...include:Review payer contracts, amendments... ...performance reporting.Establish quality-control processes for critical... ....Analyze disputed claims and reimbursement...QualitySeniorClaimsOngoing contractContract workTraineeshipLocal area- Marketing Statement NYC Health + Hospitals is the largest public health... ...mission is to deliver high quality care health services, without... ...including tracking expenses, reviewing budgets, and preparing... ...Full Audit Support for Grant Claimed items). Develop extensive knowledge...QualitySeniorClaimsWork at officeWork from home
- ...delivery outside of the hospital. We provide the... ...We work fast and with quality because we provide business... ...Role Healthie is hiring a Senior Product Manager to own... ...when in the life of a claim or a balance, and how it... ...requests with a human reviewer on every one, and our product...QualitySeniorClaimsFull timeWork at officeImmediate start
- ...designations. The coding process reviews and analyzes health records... ...be utilized for submitting claims to payers for reimbursement.... ...content of the medical record for hospital and professional inpatient or... .... Communicates to Coding Quality and Professional Manager any...QualitySeniorClaimsFull timePart timeWork experience placementWork at officeLocal areaWork from homeShift work
$79.3k
...health care costs, improved outcomes from and quality of care received, and optimal member/... ..., systems, tools and processes using claims, clinical, enrollment and provider data.... ...Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh...QualitySeniorClaimsFor contractorsWork at officeLocal areaShift work$68.4k
...enterprise matrix partners (such as quality and compliance), and/or... ...analyses from medical record reviews; proactively summarizes... ...review, including analysis of claims data to ensure chart acquisition... ...insurers and a growing regional hospital and physician network. Based...QualitySeniorClaimsFor contractorsWork at officeLocal areaRemote workFlexible hours$260k - $295k
...highly collaborative Senior Director, Health Economics... ...record of peer‑reviewed publications, congress... ...intervals, bridging therapy, hospitalization, adverse‑event... ...electronic health records, claims databases, registries,... ...timelines, deliverables, and quality. Clinical Development...QualitySeniorClaimsContract workTemporary workImmediate startRemote workVisa sponsorship$169.1k - $253.64k
...Description Senior Director, Patient Financial Services... ...) is responsible for hospital-based Billing and... ...timely billing, ensuring quality and productive handling... ...best practices to reduce claim denials, improve cash... ...leaders and managed care to review payer issues and...QualitySeniorClaimsFull timeTraineeshipWork at officeLocal area$175k - $185k
...Oral Health Care as a Senior Staff DentistAre you an... ...critical role in improving quality, supporting providers,... ...(UM) and Utilization Review (UR) programs. This role... ...adjudication of dental claims and prospective service... ...critical illness, and hospital indemnity insurance.Long...QualitySeniorClaimsRemote jobWork at officeImmediate startRelocationVisa sponsorshipFlexible hours- ...Board Certified Physicians for a remote role evaluating and reviewing disability claims. As part of our Disability Peer Review team, you can enjoy... .... Full administrative support will be provided to facilitate efficient and quality work. #J-18808-Ljbffr Dane Street, LLCQualityClaimsRemote jobFlexible hours
- ...Services in New York is seeking an experienced 2nd Level Clinical Documentation Reviewer to support a long-term engagement. This advanced CDI role focuses on complex case reviews, documentation quality, denial prevention, and physician education. Ideal candidates have at...QualitySenior
- Senior Marine Claims Executive, 120k-150k+/bonus, New York City Region/HybridGlobal insurance carrier... ...RCD in delivering efficient and high quality claims and advisory services to members... ...technical support, assist with contract review, assist with new business development,...QualitySeniorClaimsContract work
- Turing Global India is seeking a Music Domain Reviewer to support QA of LLM evaluation projects. You will review prompts across music theory... ...with project managers and AI teams to improve evaluation quality. This is a contractor role with 8-week duration. #J-18808-Ljbffr...QualitySeniorFor contractors
- ...Job Title: Senior AI QRM Reviewer Location: New York, NY (Hybrid) Contract Duration: 6 months Interview Process: Virtual... ...use cases, challenge assumptions, guide remediation, and help strengthen review quality and consistency across the portfolio....QualitySeniorContract work
- ...publishing firm in the United States is seeking experienced peer reviewers to evaluate manuscripts for academic journals. The role... ...to provide constructive feedback on research work, ensuring the quality and integrity of published content. This position offers a chance...QualitySenior
$50 per hour
A premier investment review platform is seeking experienced Certified Investment Quality Reviewers in New York. The role offers flexible independent contracting with hourly compensation ranging from $50 to $200 based on qualifications. Ideal candidates include former finance...QualitySeniorHourly payFor contractorsImmediate startFlexible hours$90k - $125k
...Senior Document Controller for Hudson Tunnel ProjectOur client is a leading global Consultancy... ...to coordinate document submissions, reviews, and approvals, ensuring the review cycle... ...requirements.Perform routine audits and quality checks to confirm document completeness,...QualitySeniorWork at office- ...principlesKnowledge on ETL concepts and Source to Target Mappings (STTM's)Data Quality Rules and Validations - Compare the Business Rules to what is... ...experience (Payer or Provider)A plus to have a knowledge around Provider / Claims space.Knowledge on CI/CD process...QualitySeniorClaims
- ...and underwriting entities. Oversee litigation issues related to claims, ensuring proper adjustment and settlement within policy limits... ...improvements to reduce costs, enhance revenue, and ensure quality, safety, and customer service standards are met. Manage and support...QualitySeniorClaims
$200k
Senior Claims & Litigation Executive / AttorneyTransportation • Trucking • LogisticsUp to $200... ...continued business growth while delivering high-quality claims and advisory services to members,... ...claims mattersAssisting with contract review and risk assessmentSupporting new...QualitySeniorClaimsContract work
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