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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 Grievances & Appeals Representative 4 (FULLY BILINGUAL English/Spanish) Remote, anywhere with-in Eastern Time Zone in Jersey City New Jersey Description The Grievances & Appeals Representative 4 manages client ..
Job Information Humana Manager, Specialty Pharmacy Sales in Jersey City New Jersey Description The Manager, Pharmacy Sales - Specialty leverages targeted geographic analysis, engages with Physician offices to influence physicians to ..
Description The Supervisor, Grievances & Appeals manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if a grievance, appeal, or further request is warranted ..
Description The Bilingual Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or further ..
Description The Supervisor, Pre-Authorization Nursing reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Supervisor, Pre-Authorization ..
... the tri-state region (formerly CareMount Medical, ProHEALTH New York and Riverside ... ProHEALTH New York and Riverside Medical Group) offers an interconnected network ... 70 specialties, working in 360..
Description . Responsibilities The Process Improvement Lead researches best business practices within and outside the organization to establish benchmark data. This individual collects and analyzes process data to initiate, develop and ..
Job Information Humana Associate Director of Clinical Audit, Payment Integrity - REMOTE in US in Jersey City New Jersey Description The Associate Director of Clinical Audit, Payment Integrity uses their clinical ..
Description The Grievances & Appeals Representative 4 manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The Grievances & Appeals ..
Description As an Engagement Specialist you will be responsible for contributing to and delivering on Humana's strategy in community based engagement. You will be responsible for effectively promoting our Medicare brand ..
Description The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on ..
Job Information Humana Medical Claims Processing Representative 2 in ... City New Jersey Description The Medical Claims Processing Representative 2 reviews ... Go365 perks for well-being Responsibilities Medical Claims Processing..
... coordination, documentation, and communication of medical services. Enjoy the flexibility of ... Management Behavioral Health Nurse completes medical record reviews from medical records sent from Behavioral Health ... of..
Posted: 31-May-23 Location: Morristown/NJ/USA Salary: Open Categories: General Nursing Required Education: High School Internal Number: 125051865 Overview Atlantic Health System is seeking a per-diem Registered Nurse for the Ambulatory Service Department ..
Job Information Humana Quality Audit Professional 2 (Grievance & Appeals) -(FULLY BILINGUAL English/Spanish) Remote, anywhere with-in Eastern Time Zone in Jersey City New Jersey Description The Quality (Non-Calls) Professional 2 ensures ..
Job Information Humana Quality Audit Professional 2 (Grievance & Appeals) -Remote, anywhere with-in Eastern Time Zone in Jersey City New Jersey Description The Quality (Non-Calls) Professional 2 ensures that products meet ..
Description The Subrogation Professional II 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 Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral ..
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 facilitate ..
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 ..
