Medical Review Specialist - Chicago

+ Utilization Review Specialists bridge between a Utilization Review Nurse and Pre-Clinical Coordinator + Facilitate and schedule appointments as needed + Maintain appropriate electronic and paper files + Interface with inter-disciplinary providers + Basic invoicing at completion ...

This role supports the end to end appeals process to ensure timely accurate and compliant resolution of member and provider appeals. You will collaborate across multiple operational teams uphold regulatory and accreditation standards and contribute to continuous improvement initi ...

We are looking for a Utilization Review Specialist to join our team The Utilization Review Specialist bridges between a Utilization Review Nurse and Pre-Clinical Coordinator providing coverage for both teams. · Initiate and maintain appropriate verbal and/or written contacts with ...

This role supports the end to end appeals process to ensure timely accurate and compliant resolution of member and provider appeals. · Responsibilities Collaborate across operational teams including the Full Service Unit FSU Provider Telecommunication Center PTC and Medical Manag ...

We are looking for a Utilization Review Specialist to join our team The Utilization Review Specialist bridges between a Utilization Review Nurse and Pre-Clinical Coordinator providing coverage for both teams. · The full UR function can be performed in applicable jurisdictions. UR ...

This position is responsible for ensuring the audit and review of electronic clinical records to ensure they accurately reflect medical record documentation to meet regulatory and accrediting compliance mandates. · This position will be responsible for oversight and review of the ...

This Medical Review Specialist role reviews and analyzes referrals and supporting documentation to determine medical necessity of medical and dental services. · Responds to inquiries sent to the department by other departments and from vendors. · Determines medical necessity on i ...

We're looking for a Utilization Review Coordinator who truly understands the substance use disorder treatment world and how payors work. · In this role, you'll be a key bridge between our clinical team and payors, making sure our clients get – and keep – the right level of care a ...

This position involves reviewing and analyzing referrals and supporting documentation to determine medical necessity of services. The job requires composing approval and denial letters as needed. · Review urgent referrals and Plan renewals to determine Medical Necessity · ...

Interacts daily with patients, insurance carriers and system staff to ensure claims are submitted and accepted in a timely manner. · ...

With direction provided by the Insurance Review Supervisor, interacts daily with patients, insurance carriers and system staff members to ensure claims are submitted and accepted in a timely manner. · ...

We are seeking a Physician Coding Review Specialist to review assigned codes and ensure accuracy according to established CPT, HCPCS, and ICD-10-CM coding guidelines. The successful candidate will have advanced knowledge of medical terminology, anatomy, and physiology. · Review a ...

This position is responsible for reviewing clinician documentation and billed codes for medical group physicians and non-physician clinicians. The reviewer will work in collaboration with coding production leads and supervisors to ensure accurate coding practices. · ...

The Lead Insurance Review Specialist serves as leader for the follow-up portion of the revenue cycle. · ...

The RN Utilization Specialist reflects the mission, vision, · and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, · and complies with all relevant policies, procedures, guidelines and all other regulatory · and accreditation standards. ...

Job Summary · Aramco is seeking a Well Intervention Specialist to join the Unconventional Resources Completion Engineering Division under the Completion Operations Department URCOD. · Plan and review well intervention activities, provide solutions for wells with integrity issues, ...

Join our Team · At IHDA we strive to create and maintain a work environment that promotes diversity, recognition and inclusion. IHDA is committed to hiring and investing in individuals of diverse talents and backgrounds to ensure a range of perspectives and experiences inform and ...

This position is housed within the Asset Management department which monitors long-term physical financial operational and administrative compliance for IHDA-assisted developments This particular position ensures operational compliance of properties assisted by IHDA loans grants ...

The Data Entry Specialist reviews and confirms work entered into systems solves issues escalates as needed. · Review and file legal documents using internal systems and email. · Participate in ongoing training to expand knowledge of industry process. · Investigate discrepancies a ...

We provide health services to underserved communities in Southland Chicago. Our approach addresses the whole person by assessing physical, spiritual, emotional and financial needs. · ...