Medical Review Specialist - Chicago

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. · The full UR function can be performed in applicable jurisdictions. UR ...

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 ...

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 ...

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 · ...

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 ...

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 ...

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

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 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. ...

The Data Entry Specialist and QC personnel facilitate the production process of accurate documentation provided to our process servers teams. · The following information aims to provide potential candidates with a better understanding of the requirements for this role. · As a Dat ...

This telework opportunity allows you to customize your schedule and caseload within the week while maintaining client-mandated turnaround times. Our reviewers are compensated on a per-case basis as a 1099 independent contractor. · Physician Specialty: Endocrinology - · Need a Gen ...

· Position Title: Compliance Analyst · Department: Asset Management  · 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 ba ...

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 ...

The Docketing Specialist is responsible for providing multi-jurisdictional litigation calendaring and docketing services to litigation teams in the firm's docketing management software. This position requires an in-depth understanding of federal, state, and local rules as well as ...

The Senior Regulatory Specialist works cross-functionally on complex and innovative projects to provide technical expertise and support in ingredient approvals... · ...

Job Title: · Accreditation Specialist · Location (city, state): · Chicago, IL (Hybrid) · Industry: · Association / Non-Profit / Higher Education · Pay: · $70,000–$75,000 annually · Benefits: · This position is eligible for medical, dental, vision, and 401(k). · About Our Client: ...