Utilization Review Nurse — Appeals & Medical Claims
$29.05 - $67.97 per hourMolina Healthcare of Illinois
Molina Healthcare in Bellevue, Washington, is looking for a Registered Nurse (RN) with at least 2 years of clinical nursing experience. You will utilize your clinical knowledge to review documentation for medical necessity and appropriate levels of care. The position involves facilitating medical reviews, resolving escalated complaints, and preparing cases for administrative hearings. Competitive compensation ranging from $29.05 to $67.97 per hour is offered. #J-18808-Ljbffr Molina Healthcare
$29.05 - $67.97 per hour
Job Summary Utilizing clinical knowledge and experience... ..., responsible for review of documentation to ensure medical necessity and... ...medical record and claim submitted support correct... ...review of appeals for denied prior authorizations... ...2 years clinical nursing experience,...MedicalClaimsHourly payWork experience placementWork at office- ...consultancy firm based in Washington is looking for a candidate to manage corporate health claims. This position involves reviewing medical records and submitting well-crafted appeals to health insurers. Candidates should possess an undergraduate and graduate degree with...MedicalClaimsWork at office
$76.5k - $103.5k
...Cambia’s dedicated team of Appeals Clinicians are living... ...Appeals Clinician I utilizes clinical expertise to... ...Bachelor's Degree in Nursing and 3 years of experience... ...insurance, coding/claims review, case management or equivalent... ...the discipline (e.g. medical vs. behavioral health)...MedicalClaimsFull timeImmediate startWork from homeFlexible hours- ...Job Description Job Description ABOUT US: Ethos Risk Services is a leading insurance claims investigation and medical management company, specializing in surveillance and fraud detection. At the forefront, we provide accurate data and actionable insights that translate...MedicalClaimsCasual workLocal areaNight shift
$120k
...and employment policies. Administers the appeal and grievance processes and make recommendations... ...activities. Administers unemployment claims and paperwork for Aegis Home Office... ...Vacation + Sick Pay + Appreciation Days ~ Medical/ Dental/ Vision ~401K Location &...MedicalClaimsHourly payWork at officeWork from homeHome office$80k - $90k
...standards and procedures. Review all expiring policies with Account... ...Bonus, Stock Purchase, Medical Plans, Prescription Drugs, Dental... ...competitive benefits, plus claim part ownership? It's this... ...that makes working at IMA so appealing. We work in teams. We sell...MedicalClaimsTemporary workInternshipLocal areaFlexible hours$90k - $120k
...Collects, manages, and reviews proposals on self-... ...review of fully insured medical, and self-funded TPA and... ...renewal analysis Utilizes actuarial models to assess... ...benefits, plus claim part ownership? It's this... ...makes working at IMA so appealing. We work in teams....MedicalClaimsContract workTemporary workInternshipLocal areaFlexible hours$95k - $105k
...benefits program Conducts reviews and works to provide guidance... ...Performance Bonus, Stock Purchase, Medical Plans, Prescription Drugs,... ...competitive benefits, plus claim part ownership? It's this... ...that makes working at IMA so appealing. We work in teams. We sell...MedicalClaimsTemporary workInternshipLocal areaFlexible hours- ...join our team for Independent Medical Examinations (IMEs). This... ...comprised of independent contract reviewers (1099) compensated on a per-... ...clinical queries to support claims management Deliver detailed... ...with medical necessity and utilization review/management expertise...MedicalClaimsExtra incomeContract workFlexible hours
- ...able to settle a high volume of claims using creative, innovative,... ...writing, legal argumentation, and medical record analysis. From there,... ...This involves filing written appeals through administrative appeals... ...duties: Quickly and efficiently review medical records and submit...MedicalClaimsWork experience placementWork at officeFlexible hours
- ...obstetric patients. Interpret and review obstetric ultrasounds. Utilize Epic and Viewpoint... ...Medicine (required). Active Washington medical license or eligibility through the... ...year (required). No malpractice claims, disclosures, or disciplinary history...MedicalClaimsDaily paidMonday to FridayFlexible hours
$23 per hour
...ensure patients receive the medication that requires pre-authorizations... ...and rectifying rejected claims and conducting necessary third... ...obtaining prior authorizations. Review accuracy and completeness of... ...Look through denials and submit appeals if requested by physician to...MedicalClaimsFull timeTemporary workWork experience placementLocal areaImmediate startFlexible hours- ...management. The ideal candidate will have active CPC certification and a minimum of 3 years in medical billing. Responsibilities include reviewing denied claims, preparing appeal letters, and collaborating with AR teams to enhance outcomes. Excellent communication skills...MedicalClaimsRemote jobFull timeWork at office
- ...of independent contract reviewers (1099) compensated on a per... .../Advisor, you will utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will... ...an interpretation of the medical necessity of services provided...MedicalClaimsExtra incomeContract work
$50k - $60k
...carrier inquiries, contract review, back-up to account... ...such as enrollment, claim, and billing issues.... ...others effectively by utilizing good communication skills... ...Stock Purchase Medical Plans Prescription Drugs... ...makes working at IMA so appealing. We work in teams. We...MedicalClaimsContract workTemporary workInternshipWork at officeLocal areaFlexible hours$48.55k - $64.48k
...upon our patients. Position The Medical Accounts Receivable Billing... ...needs. Key Responsibilities Review and monitor accounts receivable... ...of benefits) and submit appeals to secure reimbursement. Contact... ...insurance companies to verify claim status, resolve payment issues...MedicalClaimsFull timeWork at officeRemote workMonday to Friday- ...Billing Specialist. This on-site full-time role involves processing claims, managing payment inquiries, and ensuring compliance with... ...requirements. Candidates should have a high school diploma (or GED), medical billing experience, and proficiency in CPT and ICD-10. The...MedicalClaimsFull time
- ...perform data-driven analyses. Utilize SQL, Excel, and data... ...strategy. Analyze pharmacy claims, drug pricing, rebate models,... ...operations by: Managing pricing appeals, coordinating with Maxor Specialty... ...a $850 individual annual medical deductible and $25 office visit...MedicalClaimsFull timeTemporary workWork at officeRemote workWork from home
- IMA Financial Group, Inc. in Bellevue, WA is seeking a Claims professional with 7+ years of experience in Workers' Compensation. The... ...including an annual performance bonus, stock purchase options, medical plans, and flexible work options. Candidates must possess strong...MedicalClaimsFlexible hours
$125k - $165k
...programs and service lines, including utilization review, claims management, payer relations,... ...of clinical documentation supporting medical necessity and level of care. Partner... ...and submission requirements. Denials, Appeals & Accounts Receivable Develop and execute...MedicalClaimsFull timeContract workRemote work- Cambia Health Solutions is seeking an Appeals Clinician I to leverage clinical expertise in... ...appeal types, ensuring compliance with medical policies. This remote position is open to... ...candidate will have a Bachelor's Degree in Nursing, an active RN license, and at least 3...MedicalRemote job
$75 per hour
...Full benefits package, including Medical, Dental, Vision, 401k with a %... ...Responsibilities Review and update dental x-rays and chart... ...narratives and probing depths for claims. Ensure OSHA/HIPAA... ...care and a healthy work culture appeals to you, we would love to meet...MedicalClaimsFull timeLocal areaRelocation packageFlexible hours- ...respected and exclusive group of concierge medical practices since its founding in 1996.... ...compensation programs, including audits and claims Direct 401(K) Audit with CPA firm... ...Proactively implement process improvements utilizing technology and best practices...MedicalClaimsTemporary workWork at office
$18 - $25 per hour
...related experience such as customer service, medical field, or front receptionist experiences... ...charting process, prioritizing and reviewing charts for completeness. Courteously... ...treatment Preparing & submitting dental claims Preferred Job Requirements: 1+...MedicalClaimsHourly payWork experience placement- .... Handling Receipt of New Cases Intake new cases and review/verify information and requests. Draft cases by entering... ...on any information missing pertinent to processing claim. Sort, organize and create medical document listing - if required by client, and in line with...MedicalClaimsPart timeWork from home
$69.92k - $133.62k
...involves investigating and settling complex property insurance claims, with a focus on utilizing technology for virtual inspections. Candidates should... ...with an excellent benefits package, including comprehensive medical plans and paid time off. #J-18808-Ljbffr AlphaStaffHCMMedicalClaims$87.69k - $131.53k
...nuclear energy along with innovations in medical isotopes to improve human health. In 2006... ...completing year-end compliance requirements. Review and incorporate any multi-state payroll/... ...benefits broker to support insurance claims and general troubleshooting Support...MedicalClaimsPermanent employmentTemporary workWork at officeLocal areaRemote workRelocationRelocation package$147k - $325k
...clients in bid protests, contract claims, and disputes before the GAO,... ...Claims, Boards of Contract Appeals, and other tribunals... ...investigations and compliance reviews involving federal funding... ...benefits package, including medical, dental, vision, 401(k), bonus...MedicalClaimsContract workFor contractorsLocal areaFlexible hours$85k - $110k
...Please click here to review our Applicant Privacy Policy. HOW WE TAKE CARE... ...defined timelines. Oversee unemployment claims, appeals, subpoenas, and disputes. Coaching... ...or mental disability, protected medical condition, genetic information, reproductive...MedicalClaimsFull timeFlexible hours$22.5 - $30.84 per hour
...denials, rejections, and claims resubmission. Patient Accounts... ...to the team includes: Review, correct, and re-bill or appeal insurance claim denials... ...improvement projects utilizing the HealthPoint Lean Management... ...experience in the medical and/or dental setting; equivalent...MedicalClaimsHourly payFull timeTemporary workPart timeLocal areaMonday to FridayShift work
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