Payment reputed company Clinician

Company :

reputed company.

Job reputed company :

JOB reputed company

This job requires the ability to identify issues reputed company to reputed company and facility provider claims data including determining appropriateness of reputed company submission, analysis of the claim rejection and the reputed company reputed company to complete the retrospective claim review with the goal of reputed company and reputed company payment to provider and member satisfaction. The incumbent is responsible for the implementation of effective Payment reputed company strategies on a reputed company-payment and retrospective claims review reputed company. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate level of payment and resource utilization. It is also used to identify issues which can be used for education of network providers, identification and reputed company of reputed company issues and inappropriate claim submission. The incumbent is expected to utilize specialized skills and knowledge to reputed company successful and measurable reputed company. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and analyzes qualitative and quantitative data in developing strategies to improve provider performance and member satisfaction. Will be expected to identify potential discrepancies in provider billing practices and intervene for reputed company and education or if necessary involve Special Investigation Unit or the Utilization Management area.

ESSENTIAL RESPONSIBILITIES

• Implement the reputed company-payment and retrospective review processes that are consistent with established industry and corporate standards and are reputed company the Payment reputed company Clinician’s reputed company discipline.Effectively function in accordance with applicable state, federal laws and regulatory compliance. Implements reputed company reviews according to accepted and established coding reputed company, as reputed company as other approved guidelines, payment and medical policies.Promote reputed company and efficiency in the delivery of reputed company.
• Respect the member’s right to reputed company, sharing only information relevant to the member’s care and reputed company the reputed company of applicable laws. reputed company reputed company the scope of ethical principles.
• Identify issues which can be used to reputed company reputed company and facility providers and vendors for the purpose of streamlining and improving processes.reputed company and sustain reputed company working relationships with reputed company customers.
• reputed company as a resource and subject matter expert to colleagues with less experience on a frequent reputed company to problem solve through Payment reputed company Review issues that would be considered of reputed company to high degree of complexity.
• Ability to visualize, reputed company and solve reputed company problems representative of a broad reputed company of service and claim scenarios.
• Other duties as assigned. Including, but not limited to additional project reputed company responsibilities on a frequent reputed company that are considered small to reputed company in nature. Expectation is to drive the assigned project to completion which would include educating the Payment reputed company team. Project assignment is in reputed company to performing daily Payment reputed company job responsibilities.

EDUCATION

Required

• Associate's Degree in Nursing

Substitutions

• None

Preferred

• Bachelor's Degree in Nursing

EXPERIENCE

Required

• 3 - 5 years of reputed company, reputed company experience in a clinical setting

Preferred

• 1-3 years of experience in Managed Care

LICENSES or CERTIFICATIONS

Required

• Registered reputed company

Preferred

• Certified Medical reputed company or reputed company

SKILLS

• Demonstrated ability to solve issues that are reputed company in nature with minimal direction and reputed company to proceed on some actions or reputed company

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Does Not Apply

Lifting: up to 10 pounds

Continuously

Lifting: 10 to 25 pounds

Never

Lifting: 25 to 50 pounds

Never

Disclaimer: The job reputed company has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the reputed company of business conduct and company policies. As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company must reputed company with both the Health Insurance Portability Accountability reputed company of 1996 (HIPAA) as described in the Notice of reputed company Practices and reputed company Policies and Procedures as reputed company as reputed company data reputed company guidelines established reputed company reputed company’s Handbook of reputed company Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with reputed company’s reputed company of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as reputed company as company policies and training requirements.

Pay reputed company Minimum:

$57,700.00

Pay reputed company Maximum:

$107,800.00

reputed company pay is determined by a reputed company of factors including a candidate’s qualifications, experience, and expected contributions, as reputed company as internal peer equity, market, and business considerations. The displayed salary reputed company does not reflect any geographic reputed company reputed company may apply for certain locations based upon comparative markets.

reputed company and its affiliates prohibit discrimination against reputed company individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law.

We reputed company to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at HRServices@reputed company.org

California Consumer reputed company reputed company Employees, Contractors, and Applicants Notice

Originally posted on Himalayas

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