Senior Medical Necessity Review Specialist
1 dia atrás
We are seeking a highly skilled Medical Necessity Specialist to join our team. This individual will be responsible for reviewing complex claims and escalating clinical or technical claim denials for potential provider, member level or IRO/ALJ appeal.
The successful candidate will have extensive experience in medical records review, written letters of appeal on denied claims, filing complaints with state Department of Insurance, and acting as a liaison between healthcare providers for additional medical documentation or clarification.
In addition to these skills, the ideal candidate will possess strong analytical and problem-solving abilities, excellent communication and interpersonal skills, and the ability to work independently in a fast-paced environment.
Key Responsibilities:
- Review complex claims and escalate clinical or technical claim denials for potential provider, member level or IRO/ALJ appeal
- Extensive review of medical records for medical necessity criteria
- Filing written letters of appeal on denied claims
- Filing complaints with state Department of Insurance
- Liaising between healthcare providers for additional medical documentation or clarification
Requirements:
- Registered Nurse (RN) licensure
- 5 to 7 years of job experience
- Strong analytical and problem-solving abilities
- Excellent communication and interpersonal skills
- Ability to work independently in a fast-paced environment
Benefits:
- Comprehensive benefits package designed to support physical, emotional, and financial health
- Time off and retirement programs
- Well-being programs
Culture and Growth:
- Collaborative culture that values innovation, growth, and teamwork
- Opportunities for professional development and certification
- Tuition reimbursement
- Quarterly and annual incentive programs for employees who excel
This is an exciting opportunity to join a dynamic team and make a meaningful contribution to the success of our organization. If you are a motivated and detail-oriented individual with a passion for medical necessity review, we encourage you to apply for this role today.
-
Medical Content Review Specialist
1 semana atrás
Brasil beBeeReviewer Tempo inteiro R$37.256 - R$60.893Job Opportunity:We are seeking a medical professional to review ophthalmology content for clarity and accuracy.
-
Medical Content Specialist
Há 2 dias
Brasil beBeeContent Tempo inteiro R$90.000 - R$125.000Job Title: Medical Content SpecialistRole Overview:As a Medical Content Specialist, you will play a pivotal role in shaping the future of AI by producing high-quality medical and scientific content for Large Language Models (LLMs).You will collaborate with AI researchers and engineers to review and refine medical-related model outputs, identify conceptual...
-
Medical Content Specialist
Há 2 dias
Brasil beBeeMedical Tempo inteiro US$100.000 - US$140.000We are seeking a highly skilled Medical Content Specialist to join our team.This role involves creating high-quality, accurate and medically sound content for AI systems. Your expertise will shape the way these systems understand, explain and communicate clinical and biomedical information.Key Responsibilities:Create in-depth explanations of medical topics,...
-
Accurate Medical Coding Position
Há 2 dias
Brasil beBeeCoding Tempo parcial US$14.000 - US$25.000Medical Coding Specialist RoleThe position involves translating provider documentation into CPT, ICD-10, and HCPCS codes accurately.Key ResponsibilitiesReview clinical documents to assign correct CPT, ICD-10, and HCPCS codes for billable services.Maintain coding accuracy in line with CMS, Medicare, Medicaid, and commercial payer requirements.Apply modifiers...
-
Medical Director
Há 6 dias
Brasil Centene Tempo inteiroOverviewYou could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.We\'re Hiring: Full-time Medical DirectorsCentene Corporation is a...
-
Medical Director
Há 2 dias
Brasil Centene Tempo inteiroOverviewYou could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.We\'re Hiring: Full-time Medical DirectorsCentene Corporation is a...
-
Senior Clinical Director
Há 5 dias
Brasil beBeeMedicalDirector Tempo inteiro US$240.000 - US$280.000Job OverviewThis clinical leadership position plays a vital role in ensuring the quality and efficiency of post-acute care services. The ideal candidate will have expertise in medical necessity reviews, utilization management, and discharge planning.Key ResponsibilitiesConduct thorough medical necessity reviews to ensure accurate and timely authorization...
-
Medical Director
Há 6 dias
Brasil CareCentrix Tempo inteiroOverviewThis position provides clinical oversight and Utilization management of Post-Acute Care (PAC) facilities and CORE business (i.e. Home Health, DME, Home Infusion Therapy, Sleep, etc.), medically appropriate redirection to lower levels of care, coordination of discharges and post discharge follow up to prevent readmissions. A key part of the role is to...
-
Brasil beBeeMedical Tempo inteiro R$72.000 - R$86.000Job SummaryThe Medical Information Specialist position plays a pivotal role in the Medical Information Contact Center, requiring strict adherence to regulations, industry standards, and policies regarding medical information and adverse event documentation.
-
Document Review Specialist
Há 6 dias
Brasil beBeeDocument Tempo inteiro R$45.000 - R$75.000Job Title: Document Review SpecialistWe are seeking a highly organized and detail-oriented individual to join our team as a Document Review Specialist. In this role, you will be responsible for reviewing and validating procurement documents for accuracy and completeness.The ideal candidate will have proven experience in data entry, document processing, or...
