Clinical Peer Reviewer - Utilization & Compliance
$122.91k - $188.02kHealthfirst
Healthfirst is seeking a Medical Peer Reviewer based in Pennsylvania to evaluate medical necessity as part of utilization management. The role requires collaboration with various medical departments and demands flexibility in workload. The hiring range is $122,907 to $188,020, depending on experience and qualifications. The successful candidate will have a licensed medical degree, relevant board certification, and must be proficient in time management and critical thinking skills. #J-18808-Ljbffr Healthfirst
- Enlyte is seeking a qualified Utilization Reviewer who can work remotely from home. The ideal candidate performs utilization review on workers... ..., and retrospective treatment referrals. The role requires clinical judgment to ensure medical necessity, collaboration with providers...SuggestedRemote workWork from home
- ...A leading technology company in research services is looking for peer reviewers who can assess manuscripts in various medical and scientific disciplines. Candidates need a Doctorate degree, strong analytical skills, and a commitment to confidentiality. The role offers...SuggestedRemote workFlexible hours
- ...Jefferson Health is seeking a Clinical Documentation Audit Specialist to lead expert CDI reviews across designated medical records, ensuring accurate data capture and compliance with CMS and regulatory requirements. The role supports enterprise-wide quality initiatives...Suggested
- ...non‑professional staff for timely record review and ensuring accuracy of medical... ...process improvement, project work. Performs compliance audits regarding billing, procedural and... ...education initiatives to improve and enhance clinical documentation. Assist in developing and...Suggested
- ...perform accurate coding of medical records using ICD-10, CPT, and HCPCS codes. This full-time position supports coding accuracy, compliance, and reimbursement. Ideal candidates will have a minimum of 3 years of coding experience and possess CPC certification from AAPC....SuggestedFull timeRemote work
- ...a medical coding professional to support accurate billing and compliance within the health system. This role requires collaborating with... ...strong communication skills. Responsibilities will include reviewing medical records, conducting compliance audits, and generating...
$24 per hour
...patient records in the EMR system Assist with quality assurance surveys and prevention screenings Protect patient privacy in compliance with HIPAA guidelines We Require: High School diploma with at least 1 year of experience Excellent communication...Temporary workWork at officeMonday to FridayShift work- ...needs today and help you plan for the future. Responsibilities Reviewing clinical documentation to facilitate the accurate representation of... ...Previous clinical documentation improvement experience, utilization management, precertification, coding, Medicare regulations,...Work experience placement
- ...Position Summary The Clinical Documentation Improvement (CDI) Specialist... .... Conduct medical record reviews and audits to ensure... ...hospital leadership, quality, compliance, and interdisciplinary clinical... ...provider training sessions. Utilize DRG grouper software and electronic...
$50 - $60 per hour
...Remote Clinical Documentation Improvement Specialist Pay Oxford Global Resources provided pay range: $50.00/hr - $60.00/hr Base... ...of Joint Commission and CMS requirements. Familiarity with Utilization Review criteria. Must demonstrate customer service skills appropriate...Contract workRemote work$61k - $101k
## Clinical Documentation SpecialistApplylocations: US - Remote (Any location)time type:... ...comprehensive secondary clinical chart reviews to identify potential missed opportunities... ...MD to seek immediate response to query (utilizing the following AHIMA practice briefs as a...Temporary workImmediate startRemote workFlexible hours$115k - $125k
...TapestryHealth is looking for a Nurse Practitioner Clinical Reviewer to oversee Remote Patient Monitoring (RPM), Behavioral Health Integration (BHI), and Chronic Care Management (CCM) reports. This remote role requires at least 5 active NP licenses and certifications,...Remote workMonday to Friday- ...Job Description The Clinical Assistant provides clinical and administrative support to... ...requests on behalf of the physician for the review and approval by the ordering physician.... ...verify and update insurance information utilizing internal or web sources. May perform and...Hourly payTraineeshipLocal area
$35 per hour
A mobile app evaluation company is seeking a Remote Newsletter Writer to explore and test new mobile games. This entry-level role involves providing feedback about app performance and user experience, requiring no prior experience. The position offers flexibility to work...Hourly payRemote work$23 - $27 per hour
...with organizational guidelines. A bit about this role: The Clinical Associate is an integral part of Devoted Medical’s interdisciplinary... ...Identify and escalate urgent clinical needs appropriately * Utilize AI agents and provide feedback to prompts Patient Advocacy &...Full timeContract workInternshipWeekend work- ...applications. This may include monitoring and reviewing clinical documentation to ensure that clinical... ...proper reimbursement and that coding compliance is complete. Works in regional/system-... ...under general supervision and utilizes analytical and creative thinking skills...Full timeContract workTraineeshipRemote workFlexible hours
$30 - $37 per hour
...Teaching Hospital is mandatory. Core Responsibilities Medical Coding: Review complex inpatient medical records to assign accurate ICD-10-CM,... ...clarification to ensure support for coded diagnoses. Systems: Utilize VA-specific software, including CPRS, VistA, and VIRR , on a...Full timeContract workRemote workWork from homeMonday to Friday- ...in ensuring accurate coding, regulatory compliance, and optimized reimbursement. Due to organizational... ...Physician Coder is responsible for reviewing inpatient medical records and assigning... ...Collaborate with coding leadership and peers to support workflow optimization and...Full timeImmediate startRemote workMonday to FridayFlexible hours
$28 - $30 per hour
...Remote) *PT & FT Options! Work Location REMOTE - Employee must utilize their own equipment. Compensation Range E/M: $26.00–$27.00 Level... ...the new fiscal year. Responsibilities/ Job Duties Accurately reviews medical records and assigns ICD‑10, CPT, and HCPCS codes for diagnoses...Extra incomeFull timeContract workTemporary workPart timeCurrently hiringWork at officeLocal areaRemote workMonday to FridayFlexible hoursShift work$25 - $50 per hour
...HCPCS specific to podiatric procedures. Review patient records to ensure all necessary... ...coding practices, and insurance policies. Utilize medical office systems effectively to... ...are highly desirable. Knowledge of HIPAA compliance, fraud prevention, and audit readiness....Hourly payFull timeContract workWork at officeTrial period- ...AI-platform that translates clinical information into accurate sets... ...auditing across service lines to review, analyze, and enhance coding... ...Learning and Product teams. Compliance & Professional Development... ...opportunity to nominate their peers Office Location: A modern open...Full timeTemporary workWork at office
$20 - $35.72 per hour
...in a timely and accurate manner. Respond to accounts receivable when coding discrepancies must be reviewed due to payer denials. Communicate regularly with superiors, peers, billing representatives, and other stakeholders to ensure proper flow of information. Understand...Hourly payFull timeLocal areaRemote work- ...responsible for independently reviewing, analysing, and resolving... ...medical necessity guidelines Utilizes internal coding resources, payer... ...medical documentation, clinical terminology, and documented... ...with strict adherence to HIPAA compliance requirement Demonstrated...Temporary workWork at officeLocal area
- ...group health side of our business enables you to apply your clinical knowledge to review reports accompanying medical records to ensure that medical... .... We provide customized Independent Medical Exam and Peer Review programs that assist our clients in reaching the appropriate...Extra incomeFreelanceWork at officeRemote work
- ...electronic medical record while maintaining compliance with established rules and regulatory... ...appropriately to requests to code or review coded accounts for accuracy. Initiates queries... ...and/or procedures as appropriate, utilizing the established physician query process....ApprenticeshipWork at office
$25 - $30 per hour
...terminology. This position requires the ability to review and interpret medical records, prepare detailed treatment timelines, and ensure compliance with policy language and treatment... ...in a deadline-driven environment. • Utilize Google Chrome and Gmail for daily communication...Hourly payFull timeRemote work$61k - $101k
## Clinical Documentation SpecialistApplylocations: US - Remote (Any location)time type:... ...comprehensive secondary clinical chart reviews to identify potential missed opportunities... ...MD to seek immediate response to query (utilizing the following AHIMA practice briefs as a...Temporary workImmediate startRemote workFlexible hours- ...alignment. Location Address: Department: Clinical Support Work Schedule: Monday Friday (8:... .../preconceptual labs to RN for physician review. Maintain patient charts during ART... ...providers, and insurance carriers; maintain compliance with HIPAA laws and regulations. Maintain...Hourly payTemporary workWork at officeLocal areaImmediate startFlexible hoursShift workWeekend work
- A healthcare technology company is looking for a Clinical Reviewer to evaluate AI chatbots. This role requires fluency in English and a medical degree either completed or in progress. You will tackle complex healthcare problems to improve the chatbot's performance, ensuring...Hourly payRemote workFlexible hours
- ...lives of patients through science. The Clinical Assistant (Medical Assistant) II is a... ...following standards and procedures and in compliance with legal regulations. Complies with... ...verify and update insurance information utilizing internal or web sources. May perform and...Hourly payTraineeshipLocal area
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