Appeals & Claims Quality Control Reviewer
1199SEIU Benefit and Pension Funds
An established health benefit organization is seeking an individual to manage daily mail intake and assist with appeals inquiries. The ideal candidate will have a High School Diploma or GED, along with at least two years of clerical experience in a health plan context and one year in customer service. Responsibilities include triaging mail, documenting correspondence, and verifying member eligibility. Strong communication skills and familiarity with medical claims processes are essential for success in this role. #J-18808-Ljbffr 1199SEIU Benefit and Pension Funds
- ...health benefits organization in New York seeks a candidate to manage appeal inquiries and correspondence, ensuring all documentation is... ...assisting with member inquiries, and maintaining records in the claims system. Candidates should have familiarity with medical claims processing...ClaimsWork at office
- ...Job Title Responsibilities • Review, manage and triage daily mail intake, including appeals email inbox, to ensure all necessary documentation is complete and... ...appeals/inquiries by accessing QNXT (medical/hospital claims system, provider and V3 (Vi-Tech) to verify member...ClaimsWork at office
- ...As the Documentation/ Scheduling Specialist (Claims Analyst II) you will intake, analyze, validate and categorize/classify appeals hearings case documentation from appellants... ...support of the Medicare Geographic Classification Review Board (MGCRB). Highlights of...ClaimsFor contractorsWork at office
- ...experienced DRG Clinical Physician Reviewer to join our growing clinical... ...directly impact healthcare quality and reimbursement integrity.... ..., including outlier and appeal cases Collaborate with internal... ...with DRG Validation, CDI, or claims review strongly preferred ~...ClaimsRemote work
$60 - $75 per hour
...Hmong Chinese Language Document Reviewer Employment Type: Full Time,... ...questions of law for direct appeals pending before the court and... ...rules to show cause, proofs of claim, motions for summary judgment... ..., professionalism, and quality work. Here at CGS we value honesty...ClaimsFull timeWork at officeFlexible hours- ...offers a telework opportunity for a physician reviewer specializing in Hematology/Medical Oncology. The role involves reviewing medical claims and interpretations based on client-... ...maintain their medical licenses and be adept at handling insurance appeals. #J-18808-Ljbffr...ClaimsContract workRemote work
$18 - $21 per hour
...Labcorp is looking for a remote Billing Coordinator III to join our team. The position involves ensuring accurate claims mapping, producing appeals for insurance payments, and collaborating across teams to address denial issues. Applicants should have 3 or more years in...ClaimsHourly payRemote work- ...RML-PH is seeking a Billing Denials Management Specialist to enhance our revenue cycle by handling insurance claim denials. The role involves investigating claims, analyzing trends, and collaborating with teams to maximize reimbursement. The ideal candidate should have...ClaimsRemote work
- ...physician panel and offers a telework opportunity for Physician Reviewers/Advisors. In this role, you will utilize your clinical... ...records and provide independent opinions regarding disability claims. This position allows for flexibility, letting you choose your...ClaimsRemote work
$50k - $55k
...MedReview is seeking an Appeals Coordinator in the United States to manage appeals and grievances while ensuring timely resolutions. Candidates should have at least 3 years of healthcare experience, with strong problem-solving and analytical skills. Responsibilities include...ClaimsRemote work- ...(Project-Based) Key Responsibilities Deep Dive Code Review: Analyze complex codebases, focusing on firmware, drivers... ...code modules and logic gates that align with patent claim elements. Expert Support: Draft high-quality, "litigation-grade" technical write-ups and...ClaimsPermanent employmentPart timeRemote work
- ...Judi Health is seeking a certified pharmacy technician to manage incoming requests for appeals in a remote role. Responsibilities include ensuring quality standards, communicating with pharmacists, and upholding HIPAA guidelines. Candidates must have at least one year...ClaimsRemote work
$48.6k - $83.16k
...seeking a specialist for expedited appeals processing in New York City.... .... Responsibilities include reviewing appeal requests, ensuring... ...degree and possess skills in claims processing and mentoring. The... ...importance of delivering high-quality appeal resolutions. #J-18808-...Claims- ...A healthcare company is seeking a skilled Appeals Processor III to work remotely in the United States. This role involves reviewing and processing healthcare appeals related to... ...experience in healthcare appeals or medical claims and a strong understanding of CMS...ClaimsRemote work
- ...healthcare service provider in the United States seeks a Denials & Appeals Coordinator responsible for managing and resolving denials and... ...with 1-3 years of relevant experience in medical billing and claims processing. Strong analytical skills and proficiency in various...Claims
$27.88 - $36.06 per hour
...Specialist III, focusing on resolving coding-related denials and appeals while collaborating with coding professionals. This remote role... ...include preparing appeal documents and managing outstanding claims submissions. The position offers an hourly rate ranging from $2...ClaimsHourly payRemote work- ...Managed Resources, Inc. is seeking a part-time DRG Appeals Review Nurse to analyze denied MS-DRG and APR-DRG claims. This remote role requires a Registered Nurse (RN... ...with HIPAA regulations while maintaining high-quality standards. The ideal candidate will have strong communication...ClaimsPart timeRemote work
- ...A healthcare solutions company is seeking an Appeals Coordinator to support the Appeals Department with administrative tasks and manage... ...have 3+ years of healthcare experience, a strong background in claims processing, and excellent analytical and communication skills....ClaimsRemote work
- ...A leading healthcare intelligence company is seeking a Nurse Itemized Bill Reviewer to analyze medical claims and ensure compliance with industry standards. This remote position allows candidates to work from anywhere in the United States. Qualified candidates should...ClaimsRemote work
- ...Denials Coding Specialist for a full-time remote position. Responsibilities include reviewing documentation for professional coding, researching claim denials, and submitting appeals. Candidates must have proficiency in MS Office and Athena, along with certifications...ClaimsFull timeRemote workFlexible hours
- ...A healthcare organization is expanding its physician panel, seeking telework Physician Reviewers for disability claims. This role involves reviewing medical records and providing professional opinions based on clinical evidence. Candidates should have board certification...ClaimsExtra incomeRemote workFlexible hours
- ...Responsibilities Research and determine COBRA eligibility for members, spouses, and dependents of the 1199SEIU Benefit & Pension Funds Review and process COBRA benefits via the eligibility and enrollment system (V3) Communicate with members and other professionals via...
- ...All Jobs Clinical Appeals Reviewer (Licensed Healthcare Professional) Clinical Appeals Reviewer... ...at management's direction. Conducts quality reviews, as needed. Serves as a subject... ...Experience with Medicare regulations, claims processing, and the medical review process...ClaimsFull timeContract workPart timeFor contractorsWork at officeLocal areaRemote workNight shift
- ...are seeking a highly skilled Appeals Processor III (APP III) to join... ...(APP III) is responsible for reviewing, analyzing, and processing... ...: Healthcare appeals Medical claims / utilization review Insurance... ...Ensure all documentation meets quality and compliance standards #J-1...ClaimsContract workRemote work
- ...A medical review company is seeking a Physician Reviewer/Advisor to provide independent opinions on disability claims. This telework role allows physicians to earn supplemental income while maintaining a flexible schedule. Responsibilities include reviewing medical records...ClaimsExtra incomeRemote workFlexible hours
- ...A healthcare solutions provider is seeking a Physician Reviewer/Advisor for Disability Peer Review. This telework role allows for schedule... ...medical records to provide independent opinions on disability claims. Board certification is required, with the opportunity for...ClaimsExtra incomeRemote work
- ...Dane Street, LLC is looking for a Physician Reviewer/Advisor for Disability Peer Review. This telework role allows physicians to utilize... ...reviewing medical records and providing opinions on disability claims based on evidence. The position offers flexibility in...ClaimsContract workRemote work
- ...A medical consulting firm is looking for a Physician Reviewer/Advisor for Disability Peer Review. This telework opportunity offers flexible... ...medical records to provide independent opinions on disability claims while adhering to guidelines. US Board certification is...ClaimsExtra incomeContract workRemote workFlexible hours
- ...New York Workers' Compensation Report Reviewer / Quality Analyst Job Summary The New York Workers' Compensation Quality Analyst is responsible... ...‑thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation...ClaimsTemporary workRemote workWork from home
- ...is expanding its physician panel and is looking for Physician Reviewers/Advisors to provide telework services. This opportunity allows... ...flexibility. The reviewer will assess medical records for disability claims and provide independent, professional opinions based on...ClaimsExtra incomeRemote work
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