Claims Reviewer remote jobs - 135 jobs

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.

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

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

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.

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 ***************************.

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.

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

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

BerryDunn is seeking a Per Diem Coding & OASIS Reviewer to join our Healthcare group. This position is responsible for accurate review of clinical documentation, assigning of ICD-10 codes based on coding guidelines, and review of OASIS assessment items for correct responses. Ongoing education and consulting with the client are essential to the success of this review process. This is a remote position requiring the Reviewer to work independently. Our Healthcare/Not-for-Profit Practice Group is our largest industry sector. Our Home Health and Hospice Practice Area consists of over fifty professionals providing services to Home Health and Hospice providers throughout the country. In addition to coding and OASIS consulting services, our Home Health and Hospice team services include compliance services, interim management, and operational and revenue cycle consulting services. Travel Expectations: There is no travel expecation for this position. You Will Timely and accurate review of patient records at OASIS timepoints: SOC, ROC, Recert, Transfer & Discharge. Hospice coding & HOPE assessments experience is a plus. Communicate directly with internal & agency clinical staff as needed via EMR notes, MS Teams or email. Participation in BerryDunn monthly internal or external agency meetings as needed. Maintain professional and technical knowledge, including required coding and OASIS certifications and continuing education credits by attending educational workshops and reviewing professional publications. Dedicate a minimum average of 20 hours per week or 80 hours per month work availability. Other duties as assigned. You Have Excellent communication and time management skills, including the ability to prioritize tasks and manage self remotely. Minimum of 5 years recent coding, OASIS and plan of care review experience. Knowledge of clinical coding, documentation review, medical terminology, anatomy and physiology, compliance & regulatory guidelines are required Licensure & Certification: Certification in Home Health Coding required Certification in Oasis required Clinical licensure is a plus Compensation Details The hourly rate for this role is $32.00-$37.00 per hour. This rate range represents BerryDunn's good faith and reasonable estimate of the possible compensation at the time of posting. If an applicant possesses experience, education, or other qualifications more than the minimum requirements for this posting, that applicant is encouraged to apply, and a final rate may then be based on those additional qualifications; compensation decisions are dependent on the facts and circumstances of each case. The hourly rate for the finalist selected for this role will be based on a variety of factors, including but not limited to, years of experience, depth of experience, seniority, merit, education, training, amount of travel, and other relevant business considerations. BerryDunn Benefits & Culture Our people are what make BerryDunn special, and in return we strive to support our employees and help them thrive. Eligible employees have access to benefits that go beyond what's expected to support their physical, mental, career, social, and financial well-being. Visit our website for a complete list of benefits and a look into our culture: Experience BerryDunn. We will ensure that individuals are provided reasonable accommodation to participate in the job application or interview process or perform essential job functions. Please contact ********************* to request an accommodation. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. About BerryDunn BerryDunn is the brand name under which Berry, Dunn, McNeil & Parker, LLC and BDMP Assurance, LLP, independently owned entities, provide services. Since 1974, BerryDunn has helped businesses, nonprofits, and government agencies throughout the US and its territories solve their greatest challenges. The firm's tax, advisory, and consulting services are provided by Berry, Dunn, McNeil & Parker, LLC, and its attest services are provided by BDMP Assurance, LLP, a licensed CPA firm. BerryDunn is a client-centered, people-first professional services firm with a mission to empower the meaningful growth of our people, clients, and communities. Led by CEO Sarah Belliveau, the firm has been recognized for its efforts in creating a diverse and inclusive workplace culture, and for its focus on learning, development, and well-being. Learn more at berrydunn.com. #BD_ATA Don't See A Match For You At This Time? We invite you to join our Talent Connection and let's stay in touch

Job Description: Responsibilities as applicable: Take part in post-market safety surveillance activities for assigned medical devices and contribute to area projects and objectives. Identify issues and escalate them to the manager as necessary. Conduct medical safety assessments MSA for medical device complaints involving reported adverse events and occasionally technical events. This involves evaluating the seriousness of adverse events determining device relatedness and assessing whether a recurring malfunction could cause or contribute to serious injury or death. Maintain oversight of all incoming MSAs for timely completion to assist in on-time reporting Skills pharmaceutical, clinical research, regulatory Top Skills Details pharmaceutical,clinical research,regulatory Additional Skills & Qualifications Qualifications: BSN Degree or higher with active RN license Minimally 5-7 years of hands-on clinical experience Able to apply clinical knowledge to adverse event data collection and assessment. Competent in ability to present device safety event data orally and in writing. Adheres to policies and regulations. Must be Computer proficient Windows Word Excel. Experience Level Expert Level Job Type & Location This is a Contract position based out of North Chicago, IL. Pay and Benefits The pay range for this position is $40.00 - $50.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Jan 16, 2026. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

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 seeks a Clinical Reviewer to join our growing team. Job Summary: The Clinical Reviewer utilizes clinical expertise during beneficiary interaction in conjunction with contract requirements, critical thinking and utilize decision-making skills to assist with communicating medical appropriateness, while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with NCQA and other regulatory standards. * Shift Information: The hours will be 12pm - 8:30pm EST for an 8-hour shift and 10am - 8:30pm EST for an 10-hour shift. * Job Responsibilities: * Assures accuracy and timeliness of all applicable review type cases within contract requirements * Assesses, evaluates, and addresses daily workload and call queues; adjusts work schedules daily to meet the workload demands of the department * In collaboration with Supervisor, responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas * Maintains current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns * Functions as providers' liaison and contact/resource person for provider customer service issues and problem resolution * Performs all applicable review types as workload indicates * Fosters positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process * Attends training and scheduled meetings and for maintenance and use of current/updated information for review * Cross trains and perform duties of other contracts to provide a flexible workforce to meet client/customer needs * Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules The list of accountabilities 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. Qualifications Required Qualifications * Active, unrestricted LPN or RN license in the applicable state and/or a Compact State license. * Knowledge of the organization of medical records, medical terminology, and disease process required * Strong clinical assessment and critical thinking skills required * Medical record abstracting skills required * 2+ years of clinical experience in a hospital or post-acute environment required. Preferred Qualifications * Minimum of one year UR and/or Prior Authorization or related experience. * Requires excellent written and verbal communication skills * Must be proficient in Microsoft Office and internet/web navigation * Bachelor's Degree from an accredited college or university in a related field * Some knowledge of Case Management, UR and/or Prior Authorization or related experience is preferred * Experience in call center environment a plus * Experience in a behavioral health setting a plus * Bilingual (English/Spanish) a plus 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 nationwide. Our company cares about our employees, giving 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 interest you. Best of luck in your search! ~ The Acentra Health Talent Acquisition Team Visit us at ******************************** EOE 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, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law. Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide additional protection, security, and support for your career and life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Compensation The pay range for this position is below: "Based on our compensation philosophy, an applicant's placement in the pay range will depend on various considerations, such as years of applicable experience and skill level." Pay Range USD $28.37 - USD $33.00 /Hr.

Our Company is seeking a full-time 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) for a minimum of 3 years. Must have minimum of 3 year of routine coding and OASIS review under your belt. Must be a career Coder focuses on coding /OASIS at present and for at least the past year. Knowledge of at least one EMR system and must have the ability to learn others quickly and work in them efficiently and productively Must have reliable high-speed internet 40 hours/week, full-time - Office hours Monday-Friday 8-4:30pm (Work Hours - Flexible) 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 Benefits: Company provided laptop, monitors, and coding book or coding Company paid cell phone stipend Company paid Home Care OASIS & Coding Certification fees as renewals occur Company provides access to online Coding Center and Coding Manual reimbursement Productivity Bonus! Calculated on Weekly Productivity! Paid time off (10 days first year after 60-day waiting period - - 15 days 2nd year +) Eleven paid holidays per year (2 are floating holidays) Retirement (SIMPLE) plan with company matching up to 3% of salary; available immediately Company paid medical and life insurance for employees; available upon eligibility Dental, vision, dependent and supplemental insurances; available at employee expense Job Type: Full-time Pay: From $70,000.00 per year Medical Specialty: Home Health Schedule: 8 hour shift Day shift Monday to Friday Supplemental Pay: Bonus pay Education: Bachelor's (Preferred) Experience: Coding/OASIS: 3 years (Preferred) Benefits: 401(k) 401(k) matching Dental insurance Health insurance Life insurance Paid time off Vision insurance Work from home 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? License/Certification: BCHH-C or HCS-D (Required) COS-C or COQS or HCS-O (Required) RN License (Required) Work Location: Remote Healthcare Provider Solutions is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic, information, pregnancy, protected veteran status or any other protected characteristic as outlined by federal, state, or local laws.

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

Nationwide Search-Incumbent can reside anywhere in the United States - Disease Specific Care Stroke Field representative. The Disease Specific Care Field Representative applies sophisticated analysis skills and inductive reasoning skills to determine a health care organization's degree of compliance with applicable program standards. They must be able to employ advanced and sometimes nuanced communication skills to engage health care organization staff in interactive dialogues on a broad array of health care issues to assess compliance and to identify opportunities for improving compliance. Responsibilities Conducts a thorough evaluation of assigned services and programs that meet DSC certification eligibility criteria. Plans, reviews and apportions review time so that all review requirements are addressed thoroughly per program. Reviews and evaluates pre-review information; researches, collects, organizes, and interprets a large volume of information from multiple sources. Interviews staff and patients to determine level of compliance with standards. Analyzes documents, such as performance data and clinical practice guidelines, to assess the level of compliance with The Joint Commission standards, evidence of performance improvement, and quality of care. Using established review protocols: Analyzes written self-descriptive program information. Participates in and/or conducts all required conferences and interviews; analyzes all data submitted by the organization. Documents all recommendations, providing adequate indication on non-compliance. Submits review findings in a complete, accurate, and timely manner to the Central Office. Interprets and explains the intent of the standards to the organization's personnel. Consults with staff during review re: non-compliance, opportunities for improvement, and remedial action required. Recommends publications and other resources that clarify standards and/or demonstrates compliance with standards. Qualifications Advanced Degree in Nursing or Licensure as a Physician required. Board Certification in Neurology required. You must hold a CPHQ certification (Certified Professional in Healthcare Quality) through National Association for Healthcare Quality (NAHQ) at time of hire or attain by December 31, 2028. Five years clinical experience with the care of Stroke patients required. Experience with a Joint Commission Comprehensive Stroke Center strongly preferred, however will consider those with Joint Commission Primary Stroke Center experience. All positions require 100% nationwide travel. We are currently looking for candidates who are available to work .14 FTE (3 consecutive days per month) and .48 FTE (2 weeks per month). Extensive nationwide travel required. We are currently hiring for our next orientation class to take place on March 2, 2026. Joint Commission offers a comprehensive benefits package. For an overview of our benefits package, please visit our Joint Commission Career Page This job description is intended to describe the general nature and level of work performed by an employee assigned to this position. The description is not an exhaustive list of all duties, responsibilities, knowledge, skills and abilities, and working conditions associated with this position. All requirements are subject to possible modification due to business needs and/or reasonable accommodations for individuals with disabilities. Min USD $112,000.00/year Max USD $112,000.00/year

The Remote Content Reviewer is responsible for evaluating, editing, and ensuring the quality, accuracy, and appropriateness of digital content across various platforms. This role involves reviewing text, images, and multimedia materials to confirm compliance with company guidelines, legal standards, and brand voice. The Content Reviewer will play a key role in maintaining a high standard of content integrity and user experience. Key Responsibilities: Review and evaluate user-generated or company-produced content for accuracy, relevance, and adherence to established guidelines. Edit and provide feedback on content to ensure clarity, correctness, and consistency with brand standards. Identify and escalate inappropriate, offensive, or non-compliant content as necessary. Collaborate with content creators, editors, and moderators to address quality issues and develop best practices. Maintain accurate records of reviewed content, flagged items, and actions taken. Stay up to date with changes in company policies, industry regulations, and content moderation practices. Participate in regular training and calibration sessions to ensure consistency in content evaluation. Ensure all content reviews maintain strict confidentiality and comply with data privacy standards. Provide suggestions for process improvements to enhance workflow efficiency and content quality. Qualifications: Bachelor's degree in English, Communications, Media Studies, or a related field, or equivalent work experience. Minimum of 2 years of experience in content review, editing, moderation, or a related digital role. Exceptional attention to detail and ability to follow complex guidelines precisely. Excellent written and verbal communication skills. Strong analytical, organizational, and time management skills. Proficiency with content management systems and digital collaboration tools. Ability to work independently and efficiently in a remote environment. U.S. residency is required; applications from outside the United States will not be considered. Compensation and Benefits: Annual Salary Range: $48,000 - $62,000, depending on experience, education, and location within the U.S. Benefits Package: Comprehensive health, dental, and vision insurance 401(k) retirement plan with employer match Paid time off (vacation, holidays, sick leave) Professional development and training support Flexible remote work arrangements Employee wellness and assistance programs

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.

HOW YOU'LL MAKE A DIFFERENCE: This Residential Reviewer fills a remote role (work from home) in MountainSeed's Appraisal Review Department. The Residential Reviewer will be performing Standard 3 and 4 appraisal reviews for residential properties. The appraisal reviews are conducted on MountainSeed's review form. The scope of work consists of a desk review and does not include an opinion of value and there is no confirmation of data. All communications, including uploading and downloading of reports, occurs via email or our web portal. There is no printing, mailing, hard copies, etc. IN THIS ROLE, YOU'LL GET TO: Perform detailed technical and compliance reviews on residential real estate appraisals, USPAP Standard 3 & 4 Ensure that valuations are reasonably supported, credible and compliant with federal and state regulations, USPAP, FIRREA, bank policies and guidelines, and industry standards Ensuring all communication is conducted by ValuTrac system Communicate with appraisers for any report corrections and/or revisions Evaluate appraiser quality of work and provide feedback for maintenance of the Bank's appraisal panel Respond to inquiries from production staff, underwriters, and members of management regarding review decisions to resolve issues Apply for and maintain multiple state licenses to serve our clients Be able to commute for MountainSeed special projects Provide support to all areas of real estate lending as needed; demonstrate superior customer service to appraisers and employees Attend ongoing training for Commercial Real Estate Appraisal and Appraisal Reviews Attend Weekly team meetings THIS OPPORTUNITY IS FOR YOU IF YOU HAVE/ARE: Minimum - Certified residential appraiser credential in at least one state Additional state licenses a plus At least five (5) years of real-estate appraisal review experience working with or for regulated financial institutions Bachelor's degree in accounting, finance, economics or related field Familiarity with Residential Real Estate Appraisal terminology and the appropriate application of appraisal valuation techniques, appraisal methodology and understanding of appraisal theory. Knowledge of residential mortgage operations. Attention to detail for the identification of Errors and Omissions. Manage difficult problems involving multiple facets and variables in non-standardized situations. Successfully prioritize work assignments of varying complexities, track progress of said assignments, demonstrate strong organizational skills and complete work within established deadlines. Software proficiency in Microsoft Office Suite and Outlook. Establish and maintain effective and professional working relationships. Effective written and verbal communication skills. Maintain confidentiality. WHAT WE OFFER: 3 weeks of PTO, 13 company paid holidays, paid parental leave, and a flexible work environment. Medical, Dental, Vision, Life, Disability, and 401K plans begin the first of the month after 30 days of employment. OUR PURPOSE is to provide opportunities that help people thrive using their God-given abilities. OUR CORE VALUES: Be a Self-Starter. Continuously seek ways to improve yourself and the business, take responsibility, and act with urgency to solve problems. Be a Team Player. Prioritize team success over individual achievements, support your colleagues, and contribute to creating high-performing teams. Be a Patriot. Focus on the greater good of the organization, be honest about what's working, and passionately work towards making the company better. Do it Right. Uphold high standards and integrity, even when no one is watching, and always aim to do the right thing. Be Humble. Lead by serving others, value diverse perspectives, and remain open to new ideas and feedback. WHAT WE DO: As the largest commercial real estate services marketplace in the nation, MountainSeed MarketPlace offers a comprehensive range of appraisal management, review services, and more. MountainSeed Analytics platform provides real-time, accurate real estate data insights, helping clients make informed decisions in markets across the U.S. MountainSeed's Capital Markets Solutions including Loan Sale Advisory and Sale Leaseback Programs assist in enhancing an institution's financial health. MountainSeed is proud to be an Equal Opportunity Employer and provides equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, pregnancy, sexual orientation, or any other characteristic protected by law.

Review OASIS and document recommended changes in approved system Review ICD-10 coding and sequencing from documentation in the patient chart Complete documentation of results review; ensure workflow processes are timely and accurate Document reason for change and recommended reimbursement impact. Consistently meet chart equivalent targets and quality metrics Qualifications Required At least 1 year of experience medical coding or OASIS review work experience HCS-D certification HCS-O OR COS-C certification Proven ability to consistently meet deadlines High attention to detail with excellent organization skills Demonstrates learning agility; seeks out opportunities for teaching, support, and professional growth Preferred Quality assurance work experience in a post-acute setting Expectations Comfortable with remote work arrangements and virtual collaboration tools Physical demands include extended periods of sitting, computer use, and telephone communication Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate. Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart's sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart's third party screening provider. If you are located in a state which grants you the right to receive information on salary range, pay scale, description of benefits or other compensation for this position, please use this form to request details which you may be legally entitled. All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position. Netsmart's Job Applicant Privacy Notice may be found here.

The Business EXL's Castle High Value and Risk Control divisions are the nation's leading residential and commercial insurance survey providers. Castle High Value provides replacement cost estimating and loss prevention services on high value homes for personal lines insurance carriers, and is the recognized leader in the industry. EXL Risk Control evaluates commercial businesses and their operations, documenting underwriting concerns and making recommendations for risk improvement. Why Apply? Competitive pay and benefits, including paid sick leave Superb training program Work from home Flexible work hours Career advancement opportunities Tuition Reimbursement Program Excellent culture and team Pay Details: Total compensation for this position is targeted at $15.50 - $16.00 per hour. The target total compensation consists of a base hourly wage plus performance-based incentive pay. Incentive Pay is driven by productivity, turn-around time and quality, and is not sales-based . For more information on benefits and what we offer please visit us at ************************************************** Knowledge, Skills, and Abilities Needed High-degree of attention to detail Strong analytical skills and resourcefulness Excellent written communications Proficiency with computer equipment and software Ability to manage multiple projects at once, and handle time sensitive urgencies Outstanding organizational skills Responsibilities The High Value Reviewer evaluates and edits high value home appraisals as submitted by field staff and ensures exemplary quality through attention to detail. Reviewers are expected to maintain high levels of quality, time service, and productivity. Once a review is completed the High Value Reviewer ensures that the report is sent to the client.