About the Role: Our client is seeking a Claims Repricing Specialist to review and analyze medical claims for payment integrity... effectively. 🔹 Claims Review & Analysis: Assess medical claims for accuracy in alignment with insurance policy guidelines...
, and nationally recognized clinical criteria. The successful RN candidate will review both medical and pharmacy member appeals... and grievances that are the result of either a preservice, post-service or claim denial. The Appeals and Grievances RN Senior...
reviews based on clinical determination. You will review claims for medical necessity and to meet the criteria for the coding... such as Medicare and Medi-cal Conducts clinical review of claims for medical necessity, coding accuracy, medical policy compliance...
review of claims for medical necessity, coding accuracy, medical policy compliance and contract compliance Prepare...Job Description: Your Role The Facility Compliance Review team reviews post service prepayment facility claims...
statistical modeling Partner with the HEDIS data team, Clinical Quality Analytics and Medical Record Review teams to support..., develop novel analyses and reports Collect data from various internal systems (e.g. Claims processing or membership systems...
Analytics and Medical Record Review teams to support HEDIS performance improvement initiatives Qualifications... and production Collect data from various internal systems (example Claims processing or membership systems) and external systems...
– St. Mary Medical Center is a 389-bed, acute care, nonprofit hospital located in Long Beach, California. The hospital... Program. Paid Time Off (PTO). Responsibilities Position Summary: Our ideal candidate will be a Registered Nurse (RN...