Medical Jobs in San Juan

Description The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and ..

Job Information Humana Grievances & Appeals Representative 3 (Fully Bilingual English/Spanish) San Juan, PR in San Juan Puerto Rico Description The Grievances & Appeals Representative 3 manages client medical denials by ..

Description The Care Manager, Telephonic Nurse, in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction ..

Description The Medical Coding Auditor extracts clinical information ... information from a variety of medical records and assigns appropriate procedural ... assigns appropriate procedural terminology and medical codes (e.g. CPT)..

Job Information Humana Inbound Contacts Representative 2 (Fully Bilingual in English/Spanish) in San Juan Puerto Rico Description The Inbound Contacts Representative 2 represents the company by addressing incoming telephone, digital, or ..

Description The Claims Processing Representative 3 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Claims Processing Representative 3 performs advanced administrative/operational/customer support duties that require ..

Job Information Humana Grievances & Appeals Representative 3 (Bilingual English/Spanish) San Juan, PR in San Juan Puerto Rico Description The Grievances & Appeals Representative 3 manages client medical denials by conducting ..

Job Information Humana Market Leadership Advisor (Managed/Health Care Industry) San Juan, PR in San Juan Puerto Rico Description The Market Leadership Advisor manages the development, operations, and results of a health ..

Job Information Humana Outbound Contact Representative 3 (FULLY Bilingual English/Spanish) San Juan, Puerto Rico in San Juan Puerto Rico Description The Outbound Contacts Representative 3 represents the company by making outbound ..

Description Do you enjoy helping those in need? Do you love researching, analyzing medical documents to determine if something was missed? Have you ever considered yourself a detective for medical claims ..

Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The ..

Job Information Humana Business Systems Analyst Professional 2/TPA (Renewable Contract position with Full Benefits) Work at Home Puerto Rico in San Juan Puerto Rico Description The Business Systems Analysis Professional 2 ..

Description The Credentialing Assistant 3 obtains and reviews documentation to determine status in a health plan. The Credentialing Assistant 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. ..

Description The Subrogation Representative 3 identifies, investigates, and collects recoveries from third parties who are legally responsible for paying all or part of medical expenditures for an organization that provides health ..

Description The Claims Review Representative 3 makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Claims Review Representative 3 performs advanced ..

... coordination, documentation and communication of medical services and/or benefit administration determinations. ... in reviewing actual and proposed medical care and services against established ... against established CMS and Humana..

Job Information Humana Senior Business Support Professional (Fully Bilingual English/Spanish) San Juan, PR in San Juan Puerto Rico Description The Senior Business Support Professional follows established procedures and guidelines to provide ..

Description The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management ..

Description The Wellness Coach 2 supports health promotion and disease prevention and care management services. The Wellness Coach 2 work assignments are varied and frequently require interpretation and independent determination of ..

Description The Quality Assurance Technician develops and implements programs to establish and maintain quality standards of existing products and services, as well as developing programs to focus employees on the quality ..

Description The Subrogation Professional 2 iIdentifies, investigates, and collects recoveries from third parties who are legally responsible for paying all or part of medical expenditures for an organization that provides health ..

Description The Supervisor, Grievances & Appeals manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The Supervisor, Grievances & Appeals ..

Description The Claims Review Representative 3 makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Claims Review Representative 3 performs advanced ..