Job Description
Job Title: Medical Claims Reviewer
Pay: $26-30/hour - Contract to Hire
Location: Remote
Shift: First (Monday-Friday 8 AM-5 PM)
Position Overview:
We are looking for a skilled and detail-focused Medical Claims Reviewer to perform comprehensive reviews of medical, surgical, and behavioral health claims for inpatient and outpatient services. This role involves using your clinical expertise, coding proficiency, and claims processing knowledge to assess and approve claims accurately and efficiently. You will ensure claims are aligned with program benefits and assist various stakeholders by providing coding-related insights and resolving inquiries related to claims processes.
Primary Responsibilities:
Review and evaluate medical, surgical, and behavioral health claims retrospectively for both inpatient and outpatient care.
Utilize clinical knowledge and coding standards to validate claims and ensure accurate processing.
Gather and prepare the necessary documentation for case payments and approvals.
Verify adherence to program guidelines, benefits, and authorizations.
Collaborate with medical directors, peer reviewers, Claims Administration, and other departments to share relevant clinical and coding information.
Act as a resource for staff on coding and claims-related questions.
Qualifications:
High School Diploma or GED (Required).
At least 2 years of experience reviewing medical claims.
Comprehensive understanding of medical and institutional claims workflows.
Strong grasp of medical coding practices and claims evaluation processes.
High attention to detail with strong analytical and critical-thinking skills.
Effective communication skills and the ability to work across teams.
Proficiency in claims review software and related tools.
...traditional brewing methods with culinary-inspired recipes utilizing all-natural, food-centric ingredients. Some of its best-known beers include flagships Hop Gun IPA and Floridian Hefeweizen. This fast-growing company is the first production brewery in the greater Fort...
...Thompson-Industrial is looking for an Equipment Operator/Driverto join their safety conscious team in Riegelwood, NC .The Equipment Operator is responsible forgeneral labor and operating equipment within the facility. As well as ensuring daily maintenance...
...individuals to join our close-knit team and help us grow our business. Specialty Beverage is currently looking to fill a dayshift warehouse position. Monday-Friday Starting Pay: $17-$19 based on experience Responsibilities Build mixed pallet orders for retail...
...Our client, a management consulting firm, is looking for a Social Media Copywriter for a part - time remote contract. This person will be working on social media content exclusively and will have to be able to provide B2B social media work samples. This opportunity...
...presence. Our team is growing, and were looking for a creative and social media-savvy intern to join us in taking our brand to the next level!... ...assist in the creation, execution, and management of engaging content across our digital platforms. This role is perfect for a...