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  • Bill Reviewer III

    Intermed 4.2company rating

    Remote claims reviewer job

    Full-time Description Employee will work under limited supervision, meets daily production quotas in processing and auditing medical bills in accordance with the appropriate workers' compensation fee schedule by performing the following duties. This position may be considered to work from home under the following criteria: Essential Duties and Responsibilities: Codes medical bills into the company system with speed and accuracy, maintaining company production standards related to quantity and quality of output. Performs preliminary screening for appropriateness and medical necessity of services rendered. Uses CPT and ICD9/ICD10 codes, fee schedules, and other resource materials to determine appropriate reimbursement of billed services, including applicable fee schedule and/or repricing rational. Flags any problem bills to the BR supervisor. Communicates with clients and/or providers to clarify information. Forwards to Bill Review supervisor any unidentifiable unlisted procedure numbers. Ability to price hospital and surgery bills to applicable fee schedules. Ability to process reconsideration requests as assigned. May specialize in state specific or client specific areas of responsibility. Assists with bill review reporting functions (internal and external reports) May specialize in state specific or client specific areas of responsibility May assist is answering provider calls. May travel to other offices to assist with training Requirements Competency: To perform the job successfully, an individual should demonstrate the following competencies: Design - Demonstrates attention to detail. Oral Communication- Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions. Team Work - Supports everyone's efforts to succeed. Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly. Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience: High school diploma or general education degree (GED), plus minimum of one year data entry/medical billing experience; additional two years bill review experience in a workers' comp environment. Strong knowledge of CPT and ICD9/ICD10 coding and workers compensation fee schedules. Must be familiar with workers' compensation regulations and have good comprehension of company software system process. Certificates and Licenses: Must have Medical Bill Reviewer Designation - 40 hour initial certification plus continuing education hours of 16 hours every 2 years. We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records. Salary Description $25.00 - $30.00
    $57k-72k yearly est. 60d+ ago
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  • Medical Content Reviewer - Remote - Nationwide

    Vituity

    Remote claims reviewer job

    Remote, Nationwide - Seeking Medical Content Reviewer Everybody Has A Role To Play In Accelerating Healthcare Innovation If you want to be part of changing healthcare to better serve patients, you are in the right place. With Inflect Health you will join a team of individuals dedicated to optimizing healthcare for all. Join the Inflect Health Team. At Inflect Health, Vituity's Innovation Hub, we identify, develop, and invest in leading-edge technologies and solutions that strengthen Vituity's history of healthcare transformation. When you join our team, you are part of a community that is committed to sharing the future of healthcare by prioritizing the human element in innovation - focusing on the provider and patient outcomes, not just the technology. The Opportunity * Craft expert responses, showcasing your deep knowledge of medical principles to enhance machine learning of healthcare data. * Analyze samples based on provided information, demonstrating your ability to apply your expertise effectively. * Evaluate samples in sequential descending priority in a multi-step project, which will be used as inputs for a model. Required Experience and Competencies * Resume and cover letter required upon applying. * Eligibility to work in the U.S. * Expertise and experience in healthcare. * Experience using G-Suite (e.g. Google Sheets, etc.). * English language proficiency. We are excited to share the base salary range for this position is $60.00, exclusive of fringe benefits or potential bonuses. This position is also eligible to participate in our annual corporate Success Sharing bonus program, which is based on the company's annual performance. If you are hired at Vituity, your final base salary compensation will be determined based on factors such as skills, education, and/or experience. We believe in the importance of pay equity and consider internal equity of our current team members as a part of any final offer. Please speak with a recruiter for more details. Innovation and transformation are required to navigate and improve the evolving landscape of healthcare, and we believe everyone can play a role in that. We strive to be a catalyst for that transformation through improvement in healthcare delivery and the development of health technologies. If you want to make a difference, Inflect Health is the place to do it. Inflect Health does not discriminate against any person on the basis of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information (including family medical history), veteran status, marital status, pregnancy or related condition, or any other basis protected by law. Inflect Health is committed to complying with all applicable national, state and local laws pertaining to nondiscrimination and equal opportunity. Applicants only. No agencies please.
    $60 hourly 17d ago
  • Medical Reviewer, Surgical Dressings

    Verse Medical

    Remote claims reviewer job

    Our Mission: Hospital-Quality Care, Everywhere. The healthcare industry still relies on faxes and phone tag to coordinate critical care for patients at home. We think patients and the clinicians who serve them deserve better than a system stuck in 1995. Verse Medical is building the modern software infrastructure to make it happen. We're a well-funded Series C company (backed by General Catalyst, SignalFire, and Sapphire Ventures) on a mission to heal a fragmented system. Our platform connects the dots between providers, payors, and patients, ensuring people get the high-quality care they need, reliably and right where they live. We're growing fast and looking for people who are driven by this mission to join us! Our Values: The Principles That Guide Us Our values are the operating system for how we work together and with our partners. They aren't just words on a wall; they are the principles we bring to every decision, every day. We are transparent, upfront and direct. We operate with honesty and clarity. We share information openly, the good and the bad, and believe that direct, respectful feedback is the foundation of trust and progress. We value speed of iteration. We are building something new, which means we learn by doing. We prioritize rapid iteration and getting solutions into the hands of users, believing that progress is more valuable than perfection. We give 110% effort, 30% of the time. We are passionate about our mission, and there are moments that require us to go the extra mile. We believe in focused intensity when it counts, balanced by a sustainable pace that keeps our team energized for the long run. We empathize with customers to a fault. When our users face a problem, we own it. Instead of asking them to change, we ask ourselves, "How can we make this better?" We believe true innovation comes from deep empathy and a relentless focus on solving the real-world challenges of healthcare. Your Impact: How You'll Help Us Heal a Broken System This isn't just a job; it's a chance to build something that matters. As DME Medical Reviewer, you'll be shaping the future of at-home care. You'll be a key part of the team, working to ensure each surgical dressing order is fully compliant with every CMS regulation, including regulation/ policies as they are applied by MACs & UPICs. You'll translate LCDs/ Articles and MAC playbooks into checklists, fix packet defects pre‑bill, and run our ADRs/appeals processes. What You'll Achieve: A Glimpse into Your Contributions Within your first year, you will have the opportunity to: Policy → Practice Interpret and operationalize LCD L33831 + Policy Article for surgical dressings; publish practical rules (when covered, limits, documentation phrases). Stand up “go/no‑go” criteria for collagen, alginate/fiber‑gelling, foam, film, hydrocolloid; codify A‑modifier (wound count) usage, KX/GA/GZ/EY, sizing, quantity/frequency math. Pre‑Bill Controls Build a 2‑gate QA (1: clinical completeness; 2: billing correctness) and pilot it on all surgical‑dressing claims. Create/upgrade templates for various outreach. Audit & Appeals Lead UPIC/MAC ADR responses (pre‑ and post‑pay). Coach internal billing team; establish a reusable appeals library with policy citations and exemplars. Enablement & Analytics Train customer-facing team members (30‑min modules) and billers on the specific documentation that satisfies the LCD. Define and track metrics: initial denial %, appeal win %, ADR turnaround, % packets with signed POD, top‑defect Pareto. What You'll Bring: The Skills and Experience You'll Leverage We believe that diverse experiences and backgrounds lead to better solutions. While we have an idea of what will help someone succeed in this role, we are open to being convinced by your unique story and skills. If you believe you can achieve the outcomes above, we encourage you to apply. Core Skills & Experience: 3-5+ years medical‑review experience at a UPIC or MAC (e.g., Safeguard Services, Qlarant, CoventBridge; Noridian, CGS, NGS, WPS, Novitas, Palmetto). Hands‑on adjudication of surgical dressings (A6021 collagen; A6196-A6199 alginate/fiber‑gelling; A6209-A6215 foam; A6212-A6214 bordered foam; A6216-A6221 gauze; A6257-A6259 film). Expert with proof‑of‑delivery standards, SWO requirements, frequency/sizing rules, and common denial rationales (e.g., two‑cover stacking, over‑frequency without rationale, DOS/POD mismatch). Most of our interview process is focused on your practical experience with the coverage guidelines. Crisp, policy‑anchored writing; calm under deadline; disciplined with PHI. The Rewards & Reality: Compensation, Benefits & Logistics We believe in taking care of our team, both professionally and personally. Here's what we offer: Meaningful Compensation: up to $110,000 base salary (depending on experience and expertise) Comprehensive Health & Wellness: We cover 100% of your health insurance premium and provide access to high-quality dental and vision insurance plans for you and your dependents. Plan for the Future: We offer a 401(k) plan to help you save for your future. At this time, the company does not offer a 401(k) match. Career Growth: You'll have opportunities for rapid career advancement in a company that's at a major inflection point. We want you to grow with us. Work Environment & Location: This is a remote position. Please note that at this time, we are not able to provide visa sponsorship for this position. All candidates must be authorized to work in the United States. Our Pledge for an Equitable Future At Verse Medical, our mission is to deliver equitable, hospital-quality care to everyone, regardless of their background or where they live. We can only achieve this if our own team reflects the diversity of the patients we serve. We are committed to building a workplace where everyone feels a sense of belonging, where their contributions are valued, and where they can do their best work. We embrace diversity of all kinds: race, gender, age, religion, identity, experience. We are actively working to build a more inclusive and equitable world, starting from within our own walls. We are an equal opportunity employer. We are also committed to providing a positive and accessible interview experience. If you require any accommodations to participate in our process, please contact us at ***************************.
    $110k yearly Auto-Apply 40d ago
  • Spanish Content Reviewer, Editorial (Part-time) (Contractor)

    Wireless Generation

    Remote claims reviewer job

    A pioneer in K-12 education since 2000, Amplify is leading the way in next-generation curriculum and assessment. Our core and supplemental programs in ELA, math, and science engage all students in rigorous learning and inspire them to think deeply, creatively, and for themselves. Our formative assessment products help teachers identify the targeted instruction students need to build a strong foundation in early reading and math. All of our programs provide educators with powerful tools that help them understand and respond to the needs of every student. Today, Amplify serves more than 15 million students in all 50 states. For more information, visit amplify.com. Job Description: The Spanish Content Reviewer, Editorial will be responsible for reviewing Spanish-language content across products to ensure it meets standards for quality, accuracy, and adherence to Amplify's guidelines and mission. They will synthesize feedback from various partners and make recommendations that reflect product and enterprise goals. The person in this role will use their judgment, business insight, and nuanced language and communication skills to ensure Spanish-language materials follow company-wide style guidelines. The position is highly collaborative in nature, and will partner with stakeholders across the organization as well as with external advisors and subject matter experts. **This is a contract position.** Essential Responsibilities: Review and provide feedback on content in various stages of development (concepting, drafting, final product) to ensure consistency across products, accuracy and appropriateness of content, and content's adherence to company guidelines. Organize and oversee feedback from internal and external reviewers; with input from the Senior Reviewer, Editorial, synthesize feedback into coherent, consistent recommendations for revision. Work collaboratively with team members to resolve and communicate key decisions around style, formatting, and content parameters. Advise on standard terminology and style for key phrases or terms within the suite of Spanish-language products. Minimum Qualifications: Native or bilingual (Federal ILR Level 5) proficiency of the Spanish language, with a strong command of its nuanced rules in spelling, grammar, and punctuation. Degree in education or related field 3+ years of editorial experience on Spanish-language materials Excellent verbal and written communication skills Ability to navigate multiple perspectives and determine best practices for ensuring product excellence Attention to detail and proven ability to meet deadlines Preferred Qualifications: Advanced degree in related field Experience working in educational publishing Compensation: The hourly rate range for this role is $50. Amplify is an Equal Opportunity Employer. Amplify makes employment decisions based on qualifications and merit, and does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability status, veteran status, or any other legally protected characteristic or status. Amplify is committed to providing reasonable accommodations for qualified individuals with disabilities, including disabled veterans. If you have a disability and need an accommodation in connection with the application or hiring process, please email hiringaccommodations@amplify.com. . If you are selected for employment, a background check will be required. As required by state and local laws and district policies, you may be required to provide additional documentation, such as proof of vaccination, or submit to enhanced background screening, such as fingerprinting. Amplify is an E-Verify participant.
    $50 hourly Auto-Apply 6d ago
  • Content Reviewer (Spanish)

    Tech Firefly 4.0company rating

    Remote claims reviewer job

    The Content Reviewer is responsible for supporting content management, data integrity, and quality assurance processes across various projects. This role involves organizing and classifying digital assets, reviewing data for accuracy, evaluating content quality for applications, and performing quality assurance checks to ensure high operational standards. MUST BE FLUENT IN SPANISH Pay: $60,000-$80,000 salary depending on location 100% Remote in the United States Long Term Contract Opportunity Key Responsibilities Review and discover new content as assigned by the Project Manager. Utilize internal management tools to classify and assign content into a product-specific content repository and database. Record and maintain all relevant information in structured spreadsheets. Review and analyze lists of data provided by the Project Manager for a variety of project purposes. Identify inconsistencies or anomalies in data and flag or resolve them as appropriate. Review videos or other data related to the application to assess content quality and identify data issues. Apply fixes within internal tools or spreadsheets, or report unresolved issues for escalation. Ensure alignment with internal content standards and data accuracy expectations. Conduct quality checks on each type of completed work across all team members to ensure compliance and consistency. Use agreed-upon quality forms and scoring methodologies to evaluate accuracy and completeness. Maintain records of QA results and communicate findings to relevant stakeholders. Requirements Bachelor's degree or equivalent experience in Content Management, Data Operations, Media Studies, or a related field. Fluent in Spanish Strong attention to detail and data accuracy. Experience working with content management systems, databases, or spreadsheets. Familiarity with video platforms preferred. Excellent organizational and analytical skills. Ability to work independently and collaboratively with cross-functional teams. Benefits Paid Time Off Paid Holidays Subsidized Medical, Dental and Vision Insurance 401k Employee Assistance Programs
    $60k-80k yearly Auto-Apply 60d+ ago
  • Distribution Reviewer

    Nova 401 4.1company rating

    Remote claims reviewer job

    Are you looking for a position where you can utilize your experience processing retirement plan distributions and loans? Do you excel at attention to detail and catching oversights? Do you want the flexibility and convenience of working from home? Nova 401(k) Associates is looking to fill a fully remote Distribution Reviewer position. The ideal candidate for this position has at least five years of experience processing distributions and loans for qualified retirement plans, with at least two years working in a remote working environment. In this position, you will provide work quality review for retirement plan loan and distribution requests. Nova 401(k) Associates is a vibrant and growing national third party, non-producing administration firm. We have a nationally recognized sales team allowing us to grow continuously and provide advancement opportunities for our professionals. Job Responsibilities: Review distribution and loan packages, including vesting verifications Work on more complicated distributions such as QDROs, death benefits, disability benefits, and Roth conversions as needed Assist with reviewing minimum required distributions and/or ADP/ACP refunds as needed Consider cyber security issues throughout review process Exemplify thorough understanding and interpretation of plan documents regarding distributions and loans Update account managers, management, and plan sponsors as necessary on requests and progress Pursue and attain NIPA's Distribution Administrator and Loan Administrator Certificates within one month of hire Perform other related duties as required Qualifications: Five or more years of experience processing retirement plan loans and distributions Strong knowledge of ERISA and Internal Revenue Code and Regulations specific to distributions Ability to establish priorities, work independently, and proceed with objectives without supervision Superior organizational and coordination skills Flexibility, adaptability, and ability to multi-task Coachable and committed to professional development Knowledge of Corbel Documents & Pension Pro is a plus Bachelor's degree preferred Compensation and Benefits: Base Pay: $55,000 - $70,000 Salaried, non-exempt Medical, dental, disability, and life insurance 401(k) plan with Employer Match Work Location/Hours: Work from Home Must work from USA and be authorized to work for any US employer We will supply all necessary computer equipment 40 hour work week Must work each day, Monday through Friday Must work a regular schedule during normal business hours We get it. We listen. We communicate. Click Here to review our Privacy Policy
    $55k-70k yearly Auto-Apply 3d ago
  • Enrollment Reporting Reviewer (onsite)

    Keiser University

    Remote claims reviewer job

    The Enrollment Reporting Reviewer works under the Associate Vice Chancellor for Student Financial Services. The key contribution of the Enrollment Reporting Reviewer is to review, amend, and return accurate enrollment rosters to the NSLDS. Responsibilities: * Reviewing student enrollment rosters provided by NSLDS monthly * Tracking and revising all files in a timely manner * Assisting with the reporting of Gainful Employment and Financial Value Transparency (GE/FVT) data * Maintaining compliance with all federal regulations and university policies & procedures ESSENTIAL FUNCTIONS: The Enrollment Reporting Reviewer must be knowledgeable in Department of Education (ED) compliance regulations and follow the NSLDS Enrollment Reporting Guide and other ED regulations. The Reviewer must use various software tools to carry out the review and analysis of the following: * Rosters forwarded to the institution each month by the NSLDS * The institutional student information system (SIS) to match the rosters received * Internal systems to review, amend and return files to the NSLDS * Error Reports provided by the NSLDS stemming from submitted rosters * Reviewer will work with Registrar, Deans and others to resolve Enrollment data conflicts * Reviewer imports/exports files via the EdConnect System * Reviewer will work online, as needed, in NSLDS and COD and other systems as needed to validate accuracy of data * Reviewer will work Gainful Employment & Financial Value Transparency reporting Knowledge, Skills, and Experience: The Enrollment Reporting Reviewer role is primarily focused on the review of data related to federal enrollment reporting in higher education. The Enrollment Reporting Reviewer works closely with other Enrollment Reporting Reviewers to review multiple files for different schools and campuses throughout the organization. Below is an inclusive, but not exhaustive, list of various knowledge, skills, and other characteristics that are necessary for effective performance as the Enrollment Reporting Reviewer. Knowledge: * Understanding of data mining and data interpretation * Familiarity with database management systems to extract, transform & load data * Understanding of file formats and best practices for uploading & downloading data Skills: * Strong verbal and written communication for collaboration and reporting findings * Strong problem-solving skills and the ability to interpret complex data sets * Proficiency in data analysis, database management tools and file transfer protocols * Managing time effectively while maintaining a high degree of data analysis accuracy Experience: * 2 years of experience in data analysis including managing data files and troubleshooting transfer issues * 2 years quality assurance to ensure data accuracy through detailed review and data validation * 2 years working collaboratively across departments and teams Education, Experience, and Training: * Associate's degree required * Bachelor's degree preferred This is an onsite position located at the Office of the Chancellor in Fort Lauderdale, FL.
    $38k-57k yearly est. 60d+ ago
  • Title Reviewer - Remote Work from Home!

    Aldridge Pite LLP 3.8company rating

    Remote claims reviewer job

    Aldridge Pite, LLP is a multi-state law firm that focuses heavily on the utilization of technology to create work flow synergies with its clients and business partners. Aldridge Pite is a full-service provider of legal services to depository and non-depository financial institutions including banks, credit unions, mortgage servicing concerns, institutional investors, private firms, and other commercial clients. Aldridge Pite is dedicated to providing best-in-class representation across all of its Practice Areas through its unwavering subscription to three fundamental tenets: Partnership, Integrity, and Innovation. Purpose Review title reports on properties referred for foreclosure and identify any defects that may exist in the chain of title to determine whether title is clear to proceed with foreclosure or if title curative work may be needed. In addition to reviewing Georgia titles, this position will also have exposure to titles from Alabama and Tennessee properties. Specific Duties, Activities and Responsibilities Analyze and summarize title abstracts and recorded documents which affect condition of title to property (e.g., security deeds, conveyancing deeds, liens, UCCs etc.) Examine any probate documents in the chain of title Review to confirm that the legal description is valid. Experience with reading long legal descriptions and familiarity with survey terms required. May need to use Deed Plotter to check descriptions for closure Be familiar with Georgia Title Standards and identify title issues/defects (Alabama and Tennessee a plus) Compare descriptions in the chain of title to determine if vesting deed is correct and if the security deed encumbers the correct property Determine conditions required to obtain clear title through a foreclosure Examine security deeds, liens, orders, easements, plats, tax maps and surveys to verify legal description, ownership, restrictions, or conformity to requirements Review and confirm assignment chain is complete Review tax searches Verify that the information in the title search and accompanying documentation is accurate and complete Analyze encumbrances to title, familiarity with title statutes and standards, and prepare report outlining exceptions and actions required to clear title Prepare documentation of review and correspondence to transmit same with requirements to clear title to Vendor and Clients Initiate and follow-up on title issue resolution with Vendors, Attorneys and Clients to resolve title issues. Work closely with the Title Curative department Completes title related steps assigned to the firm within the client systems Assist with other duties and special projects as needed Job Requirements Bachelor's Degree Four to Six years of experience with residential real estate title and title insurance. Commercial experience a plus. Background with information technology a plus Ability to manage and prioritize large caseload Knowledge of Georgia title law and procedures Knowledge of Alabama and Tennessee title law and procedures a plus Knowledge of typical electronic default services platforms preferred (e.g. LPS, Tempo, Vendorscape) Working knowledge of general title policy underwriting standards In addition to remote work for most positions, we offer a comprehensive benefit program including: Company Paid Life and Disability Insurance plans Medical, Dental and Vision Plans with Prescription coverage 401K Retirement Savings Plan Flexible scheduling (within reason, depending on position) Generous PTO plan for all full-time employees Full equipment station at no cost for remote employees, including dual monitors Employee Assistance Plan, offering free 24/7 counseling and consulting services to support emotional health and wellbeing Wellness programs and employee discounts Learning and development training opportunities for both personal and professional growth And so much more! Aldridge Pite, LLP is fully committed to Equal Employment Opportunity and to attracting, retaining, developing and promoting the most qualified employees without regard to race, gender, color, religion, sexual orientation, national origin, age, physical or mental disability, citizenship status, veteran status, or any other characteristic prohibited by federal, state or local law. We are dedicated to providing a work environment free from discrimination and harassment, and where employees are treated with respect and dignity.
    $65k-82k yearly est. Auto-Apply 60d+ ago
  • Elsevier Clinical Content Reviewer, Specialty Specific (Part-Time, Fixed Term Contract)

    Osmosis 3.8company rating

    Remote claims reviewer job

    Job Title: Clinical Content Reviewer - PT Fixed Term Contract About Elsevier A global leader in information and analytics, we help researchers and healthcare professionals advance science and improve health outcomes for the benefit of society. Building on our publishing heritage, we combine quality information and vast data sets with analytics to support visionary science and research, health education and interactive learning, as well as exceptional healthcare and clinical practice. At Elsevier, your work contributes to the world's grand challenges and a more sustainable future. We harness innovative technologies to support science and healthcare to partner for a better world. About our Team Elsevier Health is a division of Elsevier that is committed to supporting clinicians, health leaders, educators and students to overcome the challenges they face every day. We support healthcare professionals throughout their career journey from education through to clinical practice. We believe that by providing evidence-based information, we can help empower clinicians to provide the best healthcare possible. About the Role In this role, you will work closely with Elsevier Health data and content teams to ensure accuracy of content. You will play a critical role in reviewing content that will support clinicians at the point of care and providing as-needed feedback throughout the content and product development cycle. We are only hiring MDs/DOs from the following specialties: Family Medicine, Radiology, Pathology, Anesthesiology, OB/GYN, and General Surgery Responsibilities * Collaborate with our multidisciplinary team to create and curate content focused on emerging medical technologies * Create, rate, and rank queries based on their relevance, safety, and efficacy, helping healthcare professionals make informed decisions. * Review and assess the potential impact of various technologies on medical practice, patient care, and clinical outcomes. * Stay abreast of the latest advancements in the field of healthcare technology to ensure the content remains current and up-to-date. * Provide expert insights and perspectives on the integration of emerging technologies in clinical settings. Requirements This is a part-time, fixed term PRN role. * Terminal medical degree (MD or DO), specializing in one of the following: Family Medicine, Radiology, Pathology, Anesthesiology, OB/GYN, and General Surgery * At least 2 years of post-residency clinical experience * Active and unencumbered US-based license * Direct point of care experience within the US * Demonstrated interest and engagement with emerging technologies * Be comfortable working autonomously in a fully remote environment, must have proficiency in Microsoft Office (Outlook, Teams, and Excel) Compensation and Benefits: * Pay: This role will pay between $70-$80 USD / hour depending on the type of projects. * Perks: Gain access to Elsevier Health products, join a community of talented clinicians, and have an impact on the next generation of health solutions Work in a way that works for you We promote a healthy work/life balance across the organization. With an average length of service of 9 years, we are confident that we offer an appealing working prospect for our people. With numerous wellbeing initiatives, shared parental leave, study assistance and sabbaticals, we will help you meet your immediate responsibilities and your long-term goals. Working flexible hours - flexing the times when you work in the day to help you fit everything in and work when you are the most productive Working with us We are an equal opportunity employer with a commitment to help you succeed. Here, you will find an inclusive, agile, collaborative, innovative and fun environment, where everyone has a part to play. Regardless of the team you join, we promote a diverse environment with co-workers who are passionate about what they do, and how they do it. Why join us? * Purposeful Work When you work with us, your work matters. You are part of an organization that nurtures your curiosity to stimulate innovation for the communities that we serve. * Growing Every Day Like the communities we serve, you are on a constant path of discovery to shape your career and personal development. * Colleagues Who Care You will be part of the Elsevier family. We will support your well-being and provide the flexibility you need to thrive at work and home.
    $49k-68k yearly est. Auto-Apply 60d+ ago
  • Coding & OASIS Reviewer- 1099 Contract Role/Remote Position

    Healthcare Provider Solutions

    Remote claims reviewer job

    Our Company is seeking a RN or licensed therapist coder/OASIS reviewer to join our team for home health, or home health and hospice coding, needed for immediate work in remote/work from home setting. Requirements: Must have home health or home health and hospice coding experience (cannot only be hospice experienced) Must be coding certified (BCHH-C or HCS-D), and OASIS certified (COS-C, COQS or HCS-O) Must have minimum of 3 year of routine coding and OASIS review experience Must be a career Coder focuses on coding /OASIS at present and for at least the past year. Knowledge of more than 1 EMR system and must have the ability to learn others quickly and work in them efficiently and productively Must have reliable high-speed internet and computer less than 3 years old Must have basic computer skills Must have experience with the following EMR's: WellSky, My Unity, Axxess, Kantime, MatrixCare, HHMD, HCHB, Synergy, and DSL Must be able to use Microsoft Teams, Microsoft Outlook and know how to screen share Organization and Time Management Skills: Excellent verbal & written communication skills (must be able to read, write, and follow directions in English) Work and make decisions independently Ability to work well with others Works well under pressure Adaptable and flexible Detail oriented Job Type: 1099 Contract Role Medical Specialty: Home Health Education: Bachelor's (Preferred) Experience: Coding/OASIS: 3 years (Preferred) License/Certification: One of the following: RN/PT/OT/ST Medical Coding Certification (Preferred) OASIS certification (Preferred) Coding Certified (BCHH-C or HCS-D) OASIS Certified (COS-C, COQS or HCS-O) Application Question(s): Have you used Microsoft Office and/or Microsoft Teams? Are you able to navigate multiple tabs at once? Do you have basic computer skills? Work Location: Remote Healthcare Provider Solutions is an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic, information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
    $41k-59k yearly est. 60d+ ago
  • Authorization Management Clinical Reviewer

    Wellsky

    Remote claims reviewer job

    As an Authorization Management Clinical Reviewer, you'll play a vital role in ensuring patients receive the right care at the right time. Your primary responsibility will be reviewing acute and post-acute authorizations before submission to the payer and verify medical necessity is met using InterQual guidelines. In this role, you'll collaborate with physicians, healthcare providers, and both internal and external stakeholders to support improved health outcomes. By following InterQual guidelines, you will ensure care is medically appropriate, high-quality, and cost-effective throughout the medical management process. What we're looking for: Strong acute-care clinical background with the ability to apply evidence-based guidelines. Proficiency with technology solutions, including Microsoft Office and utilization management support tools, familiarity with CarePort Care Management preferred. Licensed RN, with the ability to obtain other clinical state licensures, as needed. Flexibility to work up to two weekend shifts per month and in alignment with the following business hours: 8:00a - 8:00p (staggered shifts) eastern time on weekdays, 8:00a - 4:00p on Saturdays, and 12:00p - 4:00p on Sundays, except for WellSky-recognized holidays. Join us in shaping the future of healthcare - apply today! Key Responsibilities: Review acute and post-acute authorizations for medical necessity using InterQual guidelines. Collaborate with case managers, physicians, and medical directors to ensure appropriate levels of care. Participate in team meetings, educational activities, and interrater reliability testing to maintain review consistency and professional growth. Ensure compliance with federal, state, and accreditation standards, and identify opportunities to enhance communication or processes. Utilize knowledge of resources available in the healthcare system to assist physicians and patients effectively. Perform other job duties as assigned. Required Qualifications: Bachelor's Degree or equivalent work experience. Active RN License. At least 4-6 years relevant work experience. 2 years clinical acute nursing experience. 1-2 years' of hospital-based utilization management experience. Preferred Qualifications: Bachelor's Degree in Nursing. Denials and Appeals experience. Experience with managed care and CMS standards. UM/CM Knowledge of ICD / CPT / DRG's. Proficient in the use of window-based computer programs. Excellent verbal, written, and interpersonal communication skills. Critical thinking skills, creative problem solving, and proficient organization and planning skills. Experience with InterQual guidelines for acute-care and/or other clinical decision support tools, especially in utilization management and prior authorization processes. Experience with CarePort Care Management. Job Expectations: Willing to travel up to 30% based on business needs. Willing to work additional or irregular hours as needed. Must work in accordance with applicable security policies and procedures to safeguard company and client information. Must be able to sit and view a computer screen for extended periods of time. WellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference. WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law. WellSky is proud to be a drug-free workplace. Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates. Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky: Excellent medical, dental, and vision benefits Mental health benefits through TelaDoc Prescription drug coverage Generous paid time off, plus 13 paid holidays Paid parental leave 100% vested 401(K) retirement plans Educational assistance up to $2500 per year
    $39k-59k yearly est. Auto-Apply 5d ago
  • Dental Medical Reviewer (DDS/DMD) - PRN (Remote U.S. within Alaska Time Zone Hours)

    Acentra Health

    Remote claims reviewer job

    Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities Acentra health is looking for a Dental Medical Reviewer (DDS/DMD) - PRN (Remote U.S. within Alaska Time Zone Hours) Job Summary: * The Dental Medical Reviewer Doctor of Dental Surgery (DDS) OR Doctor of Medicine in Dentistry (DMD) - PRN will oversee Utilization Management (UM) activities to include peer review, utilization review, fair hearings and appeals, and other clinical consultations related to the applicable contract and will support the Dental UM contract. Responsibilities: * Responsible for the clinical oversight of the Dental Utilization Management program. * Collaborate with the State Medical Director or Program Director on case consultations as needed. * Must be available a minimum of four (4) hours per week. * Participate in the client's quarterly and ad-hoc contract meetings. * Review safety, sentinel, and Quality of Care events and provide detailed feedback and recommendations as per organization and policy. * Complete all secondary-level Dental Utilization Management reviews. * Develop and complete an annual review of clinical medical necessity criteria. * Participate in appeal hearings as needed. * Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. The above list of responsibilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time. PLEASE NOTE: * This role is contingent upon being awarded a contract. Start dates and final offers are contingent upon the contract award and final contract start dates. * * Work Hours: Must be available for a minimum of four (4) hours per week during Alaska Time Zone business hours. * Qualifications Required Qualifications/Experience: * Must be available to work business hours as defined by contract within the Alaska Time Zone. * AND must be available for a minimum of four (4) hours per week. * Doctor of Dental Surgery (DDS) OR Doctor of Medicine in Dentistry (DMD) degree from an accredited dental school. * D.D.S. or D.M.D. state license in good standing (licensed in the state practicing from at a minimum). * 5+ years of experience in Utilization Management (UM), Service Authorization (SA), or other clinical review processes for Medicaid or another large healthcare payer. Preferred Qualifications/Experience: * Residency within Alaska, Pacific, OR Mountain Time Zone. * 10+ years of clinical practice. * 5+ years of experience as a physician executive with significant accomplishments in developing managed care strategies, integrating delivery systems, improving quality and utilization management programs, and coaching medical staff on healthcare business and practice issues. * 2+ years of experience as a Medical Director in a managed care company. #LI-SD1 Why us? We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career. Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The Acentra Health Talent Acquisition Team Visit us at Acentra Health EEO AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. Compensation The pay for this position is listed below. "Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level." Pay Range USD $76.92 - USD $105.00 /Hr.
    $39k-59k yearly est. 17d ago
  • Scientific Project Reviewers

    Carbon Direct

    Remote claims reviewer job

    Join us on the journey to get to net zero At Carbon Direct, we dedicate our scientific, software, and business expertise to empower organizations around the world to take climate action. Our Mission Enable organizations to reduce, remove, and utilize their emissions with carbon science We are a purpose-driven carbon management firm dedicated to helping organizations around the world reach their climate goals. We make carbon science accessible and actionable with our end-to-end platform. Global citizens with global impact Whether a scientist, developer, or carbon markets expert, we are united by our mission to take climate action now. We are experts in our fields and we act with confidence. Located across 4 countries and in states all across the U.S., we offer both remote-friendly work options and dynamic, in-person experiences with offices located in Seattle, WA, Oakland, CA, and NYC. Diverse backgrounds bring diverse perspectives We recognize that teams with diverse backgrounds and different experiences are powerful. Bringing together a variety of perspectives only enhances how we can effectively address the climate crisis. Together, we are creating an environment where everyone is celebrated and anyone can succeed. About Carbon Direct Carbon Direct is a science-first organization that combines technology with deep expertise in climate science, data, and policy to deliver actionable climate strategies, and high-quality carbon dioxide removal to decarbonize the global economy. We have built a reputation as a trusted arbiter of high-quality strategy for carbon reduction, removal, and utilization throughout value chains, working with leading organizations. Our team of over 40 scientists includes thought leaders who actively contribute to the science of climate mitigation with novel assessment methodologies and public resources to facilitate action. With Carbon Direct, clients can set and equitably deliver on their climate commitments, streamline compliance, and manage risk through transparency and scientific credibility. Carbon Direct has applied its expertise to the completion of: Over 600 engineered, hybrid, and nature-based carbon credit project assessments, deep diligences for multi-year off-take agreements, and project co-design engagements. Over 150 unique emerging technology diligence reviews. Deep technical diligence de-risking engagements in improved forest management, reforestation, BECCS, and DAC, with commercial strategy support in collaboration with carbon credit developers to ensure that their products are best-in-class. Overview of the Opportunity Carbon Direct receives many client requests to diligence carbon projects. We are looking to bring on additional contractors to assist with project reviews. These cover a wide range of carbon dioxide removal and reduction technologies and would be appropriate for advanced graduate students (Masters or PhD level) in climate science fields (e.g., forestry, engineering, chemistry, environmental science, ecology) who are interested in gaining work experience. A review is generally a short report that follows a set template and examines the project proposal in the context of six quality criteria. Work is conducted with the oversight of a Carbon Direct senior scientist and subject to rigorous QA/QC. We operate a deliverable-based payment schedule based on the anticipated length and complexity of each assigned review. Equal Opportunity Employer Carbon Direct is an equal opportunity employer and does not discriminate on the basis of race, color, gender, religion, age, sexual orientation, national or ethnic origin, disability, marital status, veteran status, or any other occupationally irrelevant criteria. We adhere rigorously to our equal employment opportunity policies in connection with all employment decisions, including hiring, compensation and promotion.
    $39k-59k yearly est. Auto-Apply 60d+ ago
  • (Remote) Claims Assistant

    Military, Veterans and Diverse Job Seekers

    Remote claims reviewer job

    ESSENTIAL FUNCTIONS and RESPONSIBILITIES Evaluates residential and commercial contents inventories obtained by or submitted to VeriClaim on both a Replacement Cost and Actual Cash Value (ACV) basis. Applies limitations and/or exclusions on claims based on coverage afforded by the policy. Tracks time and log file notes for daily field activity. Assists with answering telephones. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). QUALIFICATIONS: Education & Licensing High school diploma or GED required. Resident Insurance Adjuster License (Fire and Other Hazards) preferred. Experience One (1) year customer service experience or equivalent combination of education and experience preferred. Accounting and insurance background preferred. Skills & Knowledge Oral and written communication skills PC literate, including Microsoft Office products Good comprehensive decision making skills Ability to read and comprehend policy language Ability to work in a team environment Ability to meet or exceed Performance Competencies
    $35k-43k yearly est. 60d+ ago
  • Claims Assistant

    Advocates 4.4company rating

    Remote claims reviewer job

    OverviewAt Advocate, our mission is to empower Americans to obtain the government support they've earned. Advocate aims to reduce long wait times and bureaucratic obstacles of the current government benefits application process by developing a unified intake system for the Social Security Administration, utilizing cutting-edge technologies such as artificial intelligence and machine learning, crossed with the knowledge and experience of our small team of EDPNA's and case managers. We are seeking a Claims Assistant to play a key role in ensuring smooth case management and operational support at Advocate. In this position, you will handle a variety of important administrative tasks, from managing incoming communication to scheduling appointments for case managers. You'll ensure that our administrative processes flow efficiently, contributing directly to the success of our mission. If you're organized, detail-oriented, and enjoy working in a fast-paced environment, this could be the perfect opportunity for you to make a meaningful impact.Job Responsibilities Ensure the Social Security Administration (SSA) has processed representative forms and provided access to Electronic Records Express (ERE). Manage a high volume of incoming mail as the company continues to grow. Handle calls and texts to the client care team's dedicated 888 line. Schedule appointments for case managers to keep operations on track. Request medical source statements and assist with other administrative tasks to ensure smooth process flow. Qualifications Strong administrative and clerical skills are essential. Prior experience with Social Security disability is preferred but not required. Highly organized and capable of managing multiple tasks efficiently. Strong attention to detail and task-oriented mindset. Ability to thrive in a fast-paced and growing work environment. This is a remote position and Advocate is currently a fully remote team. Advocate is an equal opportunity employer and values diversity in the workplace. We are assembling a well-rounded team of people passionate about helping others and building a great company for the long term.
    $35k-39k yearly est. Auto-Apply 60d+ ago
  • New York Real Estate Curriculum Reviewer - NYC (Contract)

    Study.com 3.9company rating

    Remote claims reviewer job

    New York Real Estate Curriculum Reviewer (Contract) Study.com is looking for Real Estate experts to evaluate and update Study.com's Real Estate content to ensure it meets current academic standards and industry requirements. Our ideal expert is knowledgeable in their field, detail-oriented, and capable of analyzing content organization. This is an online, remote contract role. Work will be paid hourly. Project Description Your role would include the following responsibilities: Research and Analysis: • Conduct comprehensive research on state-specific real estate licensing requirements • Stay updated on changes in real estate laws, regulations, and exam content outlines in the target states Course Auditing: • Review and audit existing courses for brokers and salespersons to ensure content accuracy and compliance with state requirements • Identify gaps or outdated information in course materials and recommend updates Question Bank Management: • Audit the existing practice question bank to ensure alignment with current state exam questions and formats • Review and evaluate new practice questions for relevance, accuracy, and compliance with state-specific regulations • Revise and update practice questions as needed to maintain the highest quality standards Required Skills: Active real estate license in good standing Minimum of five years of experience in the real estate industry Demonstrated expertise in state-specific real estate licensing requirements, particularly in NY Proficiency in using educational technology tools and platforms Additional Preferred Skills: Familiarity with online training courses for licensing and continuing education What We Offer: Reliable Payments: You'll receive payments twice a month and automated invoicing for your work. Remote Work: This is a fully online contracted work-from-home opportunity. Flexibility: Basically, there are no requirements! Work when you want, where you want, as often as you want, with no minimums/maximums. Support: Our supportive staff is available answer your questions and help you get up and running. About Study.com The mission of Study.com is to make education accessible, and over the last two decades we've become the leading online education platform, delivering a personalized learning experience across a broad continuum of education for over 30 million students, instructors, and professionals every month. We help empower millions of learners to achieve their education and career goals. We focus on increasing access to education because we know information is the ultimate equalizer and that education is key to upward mobility. Feel free to share this opportunity with any friends you think would be interested, too.
    $40k-60k yearly est. Auto-Apply 60d+ ago
  • Process Expert II - Claims

    Elevance Health

    Claims reviewer job in Columbus, OH

    Location: Ohio. This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The MyCare Ohio Plan program is to deliver high‐quality, trauma informed, culturally competent, person‐centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs. The Process Expert II supports the claims issue research and resolution for Home & Community Based Services (HCBS) by participating in project and process work. How you will make an impact Primary duties may include, but are not limited to: * Researches operations workflow problems and system irregularities. * Develops tests, presents process improvement solutions for new systems, new accounts and other operational improvements. * Develops and leads project plans and communicates project status. Minimum Qualifications: * Requires a BA/BS and minimum of 5 years experience in business analysis, process improvement, project coordination in a high-volume managed care operation (claims, customer service, enrollment and billing); or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities and Experiences: * Ability to analyze workflows, processes, supporting systems and procedures and identifying improvements strongly preferred. * Claims issue research and resolution for Home & Community Based Services (HCBS) highly preferred. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $66,880.00 to $100,320.00. Location(s): Columbus, OH. In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: 1st Shift (United States of America) Job Family: BSP > Process Improvement Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
    $28k-35k yearly est. 7d ago
  • Process Expert II - Claims

    Paragoncommunity

    Claims reviewer job in Columbus, OH

    Location: Ohio. This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The MyCare Ohio Plan program is to deliver high‐quality, trauma informed, culturally competent, person‐centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs. The Process Expert II supports the claims issue research and resolution for Home & Community Based Services (HCBS) by participating in project and process work. How you will make an impact Primary duties may include, but are not limited to: Researches operations workflow problems and system irregularities. Develops tests, presents process improvement solutions for new systems, new accounts and other operational improvements. Develops and leads project plans and communicates project status. Minimum Qualifications: Requires a BA/BS and minimum of 5 years experience in business analysis, process improvement, project coordination in a high-volume managed care operation (claims, customer service, enrollment and billing); or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities and Experiences: Ability to analyze workflows, processes, supporting systems and procedures and identifying improvements strongly preferred. Claims issue research and resolution for Home & Community Based Services (HCBS) highly preferred. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $66,880.00 to $100,320.00. Location(s): Columbus, OH. In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: 1st Shift (United States of America) Job Family: BSP > Process Improvement Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
    $28k-35k yearly est. Auto-Apply 8d ago
  • BPO reviewer

    Infinity International Processing Services 3.9company rating

    Remote claims reviewer job

    Infinity International Processing Services, Inc. is a leading provider of Broker Price Opinion (BPO) Quality Assurance ( Clerical Review) services to BPO/Appraisal Management Companies and Mortgage Lenders. We also provide Knowledge Process Outsourcing (KPO) and Business Process Outsourcing (BPO) services to 120+ global clients in Mortgage, Logistics, Finance & Accounting and Insurance industry. We are a global outfit having offices in Rockville, MD and India employing 1000+ employees. Towards our rapid expansion plan, we are recruiting clerical/administrative Broker Price Opinion (BPO) Reviewer cum Trainer. Job Description Responsibilities will involve reviewing of externally prepared broker price opinion reports for Clerical/Administrative errors and assuring compliance. Qualifications • Minimum of 10+ years of BPO review experience • Must be able to employ proper application of valuation techniques and methodologies • Travelling 30% ( Domestic/ International) • May have to travel to client's place for process training/transition • Handle client relation during test and ramp-up phase of new projects • Travel to offshore delivery centers in India and assist in training, project transition & ramp-up • Once offshore resources are ramped up, perform quality control • Must be able to work in a high volume production environment and meet deadlines • Good telephonic etiquette • Self prioritize tasks & work towards the same • Perform other related duties as assigned or directed by the management Additional Information Key Responsibilities:  Reviews BPOs for compliance with applicable USPAP, Fannie Mae, FHA, and client reporting guidelines, as well as completeness, consistency, logic, and appropriate valuation methodology  Approve or reject reports, requesting additional information as needed, and re-reviewing revised reports as they are received back from outside appraisers Job Type: Permanent / Work from home
    $44k-61k yearly est. 60d+ ago
  • Technical / Grammatical Reviewer - REMOTE

    Sol Engineering Services LLC

    Remote claims reviewer job

    Job Description TECHNICAL / GRAMMATICAL DOCUMENT REVIEWER- REMOTE Vicksburg, MS SOL Engineering Services, LLC is an engineering and technical services provider, with over 20 years of engineering and consulting experience. Our viability comes, in part, from utilizing the diverse backgrounds of the firm's owners and the experiences of its team of approximately one hundred engineers, scientists, technical subject matter experts, and program and project managers. Our hands-on project implementation approach encompasses management, quality, and engineering principles to ensure effective management and delivery of all projects. SOL's reputation and keys to success are built on providing high quality, responsive engineering and related technical services while maintaining professional commitments and ensuring that full satisfaction is given to our clients throughout the United States. SOL Engineering Services, LLC is searching for a Technical / Grammatical Document Reviewer to review draft documents and analyze graphic and technical information, to provide specific feedback to the authors for their consideration with respect to technical or grammatical points. Requirements Requires at least a BS/BA in English or similar, related field where the individual has demonstrated skills in reviewing written material and assuring sound grammatical structure, formatting, organization, technical content, punctuation, and structure. Requires strong technical acumen related to engineering and/or scientific research. Technical documents may include but technical reports, papers, journal articles, military field manuals, abstracts, technical letters, special reports, and presentation briefings. Must be able to format, edit and proof written work products, and ensure all materials meet established standards of appearance, consistency, and content under tight schedules and strict deadlines. Must be a U.S. citizen, able to pass a background investigation (financial and criminal) and apply for and maintain up to a Secret clearance, as well as having a valid driver's license. Solid Mathematics and basic computer skills are desirable. Work will be conducted in an office setting, and teleworking may be an option. No travel will be required. We offer a competitive salary, health benefits and paid vacation. Veterans and HUBZone residents are encouraged to apply. Equal Opportunity Employer
    $44k-64k yearly est. 19d ago

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