CERiS Jobs in United States

The Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation. · ...

The Appeals Team Lead will be responsible for providing expertise in reviewing appeals and grievances. Corresponds with parties regarding appeal issues. · Answer team questions as neededMonitor and work QC queueDistribute appealsCreate response to address issues raised by an empl ...

+The Provider Management Analyst is responsible for verifying provider information and requests for documentation to audit claims including but not limited to itemized bills, medical records, UB04's, HCFA's etc. · + · ++Communicate with respective leadership on any issues or prob ...

The Appeals (Provider Relations) Supervisor is responsible for daily operations within the Provider Relations department.The Supervisor manages and prioritizes staff daily work assignments necessary to ensure the timely and accurate processing of internal and external requests al ...

The Account Executive is responsible for interacting with customers and prospects on an executive level and acting as an extension of the client; selling new services. · ...

The CERIS Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care. Clinical and/or technical expertise is utilized to addr ...

+<b>Job Summary</b><br><p>Oversee all aspects of the Document Processing Department including personnel hiring quality assurance workflow accountability tracking staff production standards department expectations.</p><br/>+<b>Responsibilities</b><br/><ul> Ensure timely accurate ...

The Appeals Team Lead assists injured workers, claims examiners, attorneys, providers etc. in locating · providers within the medical provider network (MPN), verifying provider inclusion in an MPN and scheduling appointments upon request for · the injured worker. This role is r ...

Job Details · Description · The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a UBIB submitted by a medical facility to determine accuracy of billed charges. · This is a remote position. · Essential Functions & Responsibilities · Co ...

The Closing Analyst is responsible for closing client files and applying results into Scheck and CareMC systems to meet daily production expectation and standards. · This is a remote role. · Essential Functions & ResponsibilitiesClose client files in the appropriate manner, dicta ...

The Provider Management Analyst is responsible for verifying provider information and requests for documentation to audit claims. · This is a remote position. · ...

Job Details · Description · Responsible for managing daily production (file flow) of designated department, which may include one or more of the following functions: human resources, customer service, and promoting positive influence over Setup Analysts. · This is a remote positi ...

Customer Service Representative I · The Customer Service Representative role is a remote position responsible for addressing client and provider inquiries via various communication channels. Key objectives include analyzing client and provider inquiries, performing reviews of cla ...

Policy & Payment Integrity Coordinator I · The PPI Coordinator plays a key role in supporting the Policy and Payment Integrity teams by managing workflow, ensuring timely assignment of appeals, and maintaining accurate tracking systems. This position requires strong organizationa ...

Job Details · Description · The CERIS Operations Supervisor is responsible for managing daily production for the department, which may include one or more of the following functions: human resources, customer service, and promoting positive mentorship for the team. · This is an o ...

The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a UBIB submitted by a medical facility to determine accuracy of billed charges. · This is a remote position. · ESSENTIAL FUNCTIONS & RESPONSIBILITIES:Collects supporting data and ana ...

body{font-family:Arial}Appeals Team Lead · The Appeals Team Lead assists injured workers, claims examiners, attorneys and providers in locating suitable medical professionals within a designated network scheduling appointments for the injured worker as needed. · <ul style= ...

Job Details · Description · Responsible for managing daily production (file flow) of designated department, which may include one or more of the following functions: human resources, customer service, and promoting positive influence over Setup Analysts. · This is a remote positi ...

Correspondence Team Lead · This is a remote position responsible for monitoring and tracking all processes pertaining to the Correspondence Team. · Creates and maintains reports in worksheets using Excel formulas. · Runs queries to collate data from different sources. · Merges do ...

Medical Record Analysts · A Medical Record Analyst's primary responsibility involves verifying provider information and requesting documentation to audit claims including but not limited to itemized bills and medical records. · ...