Clinical Medical Claims Reviewer
Blue Cross and Blue Shield of Louisiana Inc.
Blue Cross and Blue Shield of Louisiana seeks an LPN to coordinate, process, and manage inpatient and outpatient claims from a medical standpoint, ensuring proper administration of contractual limitations and exclusions. The role requires 4 years of LPN experience with at least 1 year in authorization, medical review, and case management, plus strong knowledge of medical terminology and code sets. Louisiana residency is preferred. #J-18808-Ljbffr Blue Cross and Blue Shield of Louisiana Inc.
$59.09k - $85.05k
...participating in the planning, coordinating and collecting of clinical process and outcome data. In this role, you will work in collaboration... ...or equivalent clinical experience is required* Recent medical record abstraction preferred**Why MultiCare?** **Rooted in the...SuggestedContract workLocal areaRemote workShift work- ...At Houston Methodist, the Clinical Documentation Specialist RN position is responsible for... ...clinical documentation. This position analyzes medical records for DRG's, complications, and... ...hospital setting Coding and utilization review experience preferred Licences and Certifications...SuggestedPermanent employment
$86.4k - $138.6k
## Senior Clinical InformaticistApplyremote type: Remotelocations: PA, Working at Home - Pennsylvania: MD, Working at Home - Maryland:... ...Intelligence or Reporting* 1+ years of working with healthcare claims data* Experience supporting academic or scholarly research, including...ClaimsWork at officeWork from home- ...seeking a Quality Data Abstractor (RHIT) to join a remote, US-based team. You will participate in planning, coordinating and collecting clinical process and outcome data, collaborating with program leadership. The role emphasizes accurate data entry, completeness, and...SuggestedRemote job
- ...seeking experienced Podiatrists licensed in Louisiana to join our panel as independent reviewers. This fully remote 1099 role involves evaluating medical records, producing concise clinical summaries, and offering independent opinions on foot and ankle conditions,...SuggestedRemote jobFor contractors
- ...expert investigative services. We investigate all types of insurance claims including workers' compensation, suspected fraud, liability and... ...of an assignment based upon the case manager's instructions Review all case materials prior to conducting investigative activity Complete...ClaimsFlexible hours
- ...and experienced independent adjusters. The program supports licensing and provides training in Xactimate, property inspection and claims workflows, enabling candidates to enter the insurance adjusting field. New to the industry? The company offers training and licensing...Claims
- Great American Insurance Group is seeking a part-time Crop Adjuster in Louisiana to manage claims for various crops. Responsibilities include field inspections, evaluating coverage, and ensuring compliance with regulations. The role demands proficiency in claims handling...ClaimsPart timeSeasonal work
- Mobilitas is hiring a Commercial Insurance Consultant - Claims Insights (Remote) to transform data into decision-ready insights that drive business performance, portfolio management, and risk outcomes. You will perform complex analyses, identify trends, evaluate performance...ClaimsRemote job
- ...for timely and accurate submission of primary, secondary or other claim types to the appropriate payer source. Prepares billing reports... ...to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. #J-18...ClaimsFull time
- ...copayments and patient balances. To scan or file all documents into the Medical Record as needed. **Minimum Qualifications:**Must be able to... ...to our mission, vision and values. Please take time to review those expectations, which can be found **by clicking here**, before...Work at officeMonday to FridayShift work
- This job performs appointment scheduling and medical assistant functions within a clinic setting. Provides individualized, direct patient care of assigned patients under the supervision of a licensed healthcare provider and assists in the implementation of the delivery...Work at officeLocal areaImmediate start
$15 - $20.16 per hour
...Federally Qualified Health Center with 10 clinics in 5 parishes. Job Duties Greet... ...balance cash drawer Check patient balance; review any payment plans Process sliding fee discount... ...registration, billing, coding and claims reconciliation, preferred Experience with...ClaimsHourly payFull timeMonday to Friday$31.02 - $48.54 per hour
...hospital managers, staff, QI teams, clients (i.e. physicians, clinics), coworkers and other customers and associates. Effectively communicates... ...other healthcare financial information experience; electronic claims system experience***Disclaimer:*** *The job description has...ClaimsWork from home$46.99k - $122.4k
...Investigates to prevent payment of fraudulent claims committed by insured's, providers,... .... Researches and prepares cases for clinical and legal review. Documents all appropriate case... ...The benefits for this position include medical, dental, and vision coverage, paid time...ClaimsHourly payFull timeTemporary workLocal area- ...policy functions inclusive of prepayment clinical and coding requirements and post payment recoupment, to promote accuracy in claims payment and correct coding to drive savings... ...Vice President will partner across Finance, Medical Economics, Provider Network Management,...Claims
- ...and relevant coding certification. The ideal candidate will have a strong understanding of medical terminology and coding regulations, and will effectively communicate with clinical staff to resolve documentation issues. This position offers variable work hours in...
$80.3k - $133.8k
...Benefit Investigation, Prior Authorization, Claims Assistance, and Appeals) and educating... ...appropriate claims submission, Specialty Pharmacy, Medical Benefit Interpretation, understanding... ...adjudication, physician’s office or clinics. Must have Medicare and commercial...ClaimsWork at officeRemote work- Overview This job reviews and accurately codes and abstracts the most... ..., and all other complex medical services. The role utilizes appropriate... ..., and collaborates with the Clinical Documentation Improvement... ...DNFB, Pre-AR, denials, and claim edits. Verify correct...ClaimsRemote jobWork experience placementLocal areaImmediate startNight shift
- WK Medical Center Shreveport, LA Non-Medical Full-Time, Day, 7:30 AM - 4:00 PM Position... ...Patient Access Manager collaborates with clinical departments, physician offices, business... ...and Clinical Departments to improve clean claim rates. Monitor registration accuracy and...ClaimsFull timeWork at officeShift work
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$150k - $275k
...Admitted to practice law in Louisiana Responsibilities Managing their own docket of cases Set up claims and track medical treatment Supervise medical clerk and case manager Review demands Negotiate with adjusters Communicate the offer to the client and the disbursement of...ClaimsFull time- ...reimbursement support for a defined territory, including education for offices, benefit investigations, prior authorizations, and claims assistance. The role requires building strong relationships with physician offices and manufacturers, traveling 80% of the time, and...ClaimsRemote work
- ...modern technology information, reviewing and analyzing reimbursement... ...official coding guidelines, medical terminology, anatomy and physiology... ...action plan to reduce clinical denials and coordinates department... ...of unpaid and partially paid claims by third-party payors related...ClaimsWork at office
- A leading claims solutions provider is looking for Independent Adjusters to evaluate exterior and minor interior property damage. Responsibilities include drafting detailed damage descriptions and using Xactanalysis software. Candidates should hold a current Xactimate...ClaimsFlexible hours
- Ahhmgt is seeking a Billing Specialist in DeQuincy, LA. The role involves the timely submission of various claims and preparing reports for leadership. Candidates should have two years of experience in insurance billing, preferably in Medicare or Medicaid. The ideal applicant...ClaimsFull time
- ...(BCBSLA) Mission Statement. Reviews treatment procedures and services... ...by generally accepted medical evidence when formal guidelines... ...requiredMust be qualified to render a clinical opinion about the medical... ...licensure requirements, claims review to determine proper resolution...ClaimsContract workWork at officeLocal areaRelocation
$50k - $100k
...Filing lawsuits Drafting and answering discovery Preparing clients for depositions, mediations, motion hearings, and trials Evaluating claims with claims representatives Collaborating with paralegals and legal secretaries to propound and respond to written discovery, order...ClaimsFull timeLocal areaShift work- Practical Adult Insights in Louisiana, MO, seeks a catastrophe adjuster to inspect property damage from disasters like earthquakes and floods. Responsibilities include evaluating damage and communicating findings to policyholders. A high-school diploma, state license, and...Claims
- Great American Insurance Group seeks a remote Claims Operations Associate II to support workers' compensation claims professionals. You will handle claim setup, documentation, and inquiries, partnering with adjusters to ensure accurate processing. Strong organization and...ClaimsRemote jobMonday to Friday
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