Utilization Review Specialist Department: Claims Administration & Adjusting Employment Type: Permanent - Full Time... insurance and regulated sectors. The Utilization Review Specialist is responsible for performing utilization review services...
across all cancer types. About the Role The Case Review Specialist ensures that case documentation is provided by the provider... 14 million people in the US and Puerto Rico, OncoHealth offers digital solutions for treatment review and virtual care...
, GA Description: The Operational Excellence Specialist II at Emory Healthcare plays a key role in driving continuous improvement... Sigma methodologies, the Specialist II independently manages moderate-to-complex projects and serves as a knowledgeable...
Description The Operational Excellence Specialist II at Emory Healthcare plays a key role in driving continuous... and Six Sigma methodologies, the Specialist II independently manages moderate-to-complex projects and serves...
Prior experience of working in inpatient case management or utilization review is preferred Strong medical surgical... (United States of America) The Remote Clinical Documentation Specialist (CDS) demonstrates strong clinical knowledge...
Job Type: Permanent Build a brilliant future with Hiscox The Senior Complex Claims Specialist is the most senior... allocation Draft and Review coverage analyses Manage/Partner with local defense counsel while monitoring litigation Drives...
of working as a CDI/Coding auditor is preferred Prior experience of working in inpatient case management or utilization review... (United States of America) Job Summary: The Remote Clinical Documentation Specialist (CDS) demonstrates strong clinical...
· Experience in utilization review and/or quality assurance in a healthcare setting · Experience in conducting assessments...Job Title: Intake and Triage Specialist- Atlanta Paygrade: L Workplace: Hybrid Travel: no regular travel expected...
for areas of improvement identified through utilization review, clinical records audit, claim denials, patient satisfaction... processes and regulations within a specified area and takes on informal leadership positions to review and act on results...
, etc.) Timely review of all control sequences and components to identify any potential scope gaps, sequence gaps, etc., as well... project schedule. Utilization of Project Support Center personnel for Revit work; copying, assembling, and delivery...
, Utilization Review ("UR") regulations and Medicare guidelines regarding medical necessity, inpatient, outpatient and observation... inpatient records, state guidelines for coding Medicaid records, Utilization Review ("UR") regulations and Medicare guidelines...
. Assists in the development of evaluation and management and other billing code utilization reports for comparison to national...), or Certified Coding Specialist – Physician-based (CCS-P) Knowledge, Skills, and Abilities Strong knowledge base in complete...
and American College of Surgeons. 3. Employs defensive abstracting techniques for utilization in patient treatment summaries. 4... but not limited to visual review, computer edit checks, audits, data query, re-abstracting studies, and reliability studies 14...
for utilization in patient treatment summaries. 4. Performs follow-up on cases abstracted. 5. Completes collaborative staging... of abstracts using a variety of methods including but not limited to visual review, computer edit checks, audits, data query, re...
discharge and completes assessment of member status. Coordinates and communicates plan of care to the Primary and/or Specialist..., development, implementation, and maintenance of all QRM policies and procedures. Monitors utilization trends concerning inpatient...