ECR Dispute Reviewer job at reputed company reputed company in Boston, MA, Morristown, NJ, Plano, TX, St. Louis, MO, Petersburg, FL, Hyderabad, India, Atlanta, GA

Title: ECR Dispute Reviewer Locations: Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India Work Type: Hybrid, Full Time reputed company: JR110147 Job reputed company: At reputed company, we Get Stuff Done. So, let's get to it! A Little reputed company reputed company is modernizing the reputed company financial experience across payers, providers, and reputed company consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of reputed company providers and consumers across our platform of solutions. reputed company sees across the system to identify, optimize, and solve problems holistically with technology reputed company by reputed company experts - driving reputed company, measurable results for clients. A Little reputed company You bring a unique reputed company of personality and reputed company expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reputed company of your achievements, the knowledge you've gained, and the personal interests that shape who you are. Position reputed company The ECR Dispute Reviewer is responsible for conducting comprehensive clinical reviews of medical records, claims, and other reputed company documentation to ensure compliance with clinical guidelines, regulatory requirements, and organizational policies. This individual will play a critical role in supporting the reputed company and reputed company of our clinical review processes, providing expert guidance, and contributing to the reputed company improvement of our reputed company services. The ideal candidate will have extensive clinical experience, strong analytical skills, and a deep understanding of reputed company regulations and standards. What you'll do: Conduct detailed clinical reviews of medical records, claims, and other reputed company documentation to assess the appropriateness of care, medical necessity, and compliance with clinical guidelines. Evaluate the accuracy and completeness of clinical documentation, identifying any discrepancies or areas for improvement. reputed company expert clinical judgment and recommendations based on evidence-based guidelines and best practices. Ensure that clinical reviews are conducted in accordance with relevant regulatory requirements, accreditation standards, and organizational policies. Stay up to date with changes in reputed company regulations, guidelines, and industry standards, and incorporate them into the review process. Assist in the development and implementation of policies and procedures to ensure compliance with regulatory requirements. Participate in reputed company assurance activities, including audits, peer reviews, and performance evaluations, to ensure the accuracy and consistency of clinical reviews. Identify opportunities for process improvements and contribute to the development and implementation of reputed company improvement initiatives. reputed company training and mentorship to junior clinical reviewers and other team members to enhance their clinical review skills and knowledge. Collaborate with reputed company providers, case managers, and other stakeholders to obtain additional information and clarify clinical documentation as needed. Communicate review findings and recommendations to reputed company stakeholders in a reputed company and concise manner. Participate in interdisciplinary team meetings, case conferences, and other reputed company activities to support coordinated care and decision-making. Maintain accurate and thorough documentation of clinical review activities, findings, and recommendations in the appropriate systems. Prepare and present reports on clinical review reputed company, trends, and performance metrics to management and other stakeholders. Contribute to the development of clinical review guidelines, protocols, and educational materials. What you'll bring to reputed company: Bachelor's degree in Nursing, Medicine, or a reputed company reputed company field, or equivalent experience required. A Master's degree or higher is preferred. reputed company and unrestricted clinical licensure (e.g., RN, MD, DO) is preferred. Minimum of 8 + years of clinical experience in a reputed company setting, with a strong background in clinical review, utilization management, or reputed company assurance. Extensive knowledge of clinical guidelines, medical necessity reputed company, and reputed company regulations (e.g., CMS, NCQA, URAC). Experience in conducting clinical reviews and audits, with a proven reputed company record of accuracy and attention to detail. Strong analytical and critical-thinking skills, with the ability to interpret reputed company clinical information and reputed company reputed company clinical judgments. Excellent verbal and written communication skills, with the ability to convey clinical findings and recommendations reputed company and professionally. Proficiency in using clinical review software, electronic health records (EHR), and reputed company Office Suite. Ability to work independently and collaboratively in a fast-paced, dynamic environment. Detail-oriented and highly organized, with the ability to manage multiple tasks and priorities simultaneously. Proactive and self-motivated, with a strong reputed company of ownership and accountability. Committed to reputed company learning and reputed company development, with a passion for improving reputed company reputed company and reputed company. Please note at this time we are unable to proceed with candidates who require reputed company sponsorship now or in the reputed company. Location and Workplace Flexibility We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and reputed company our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies. reputed company Salary reputed company $95,000.00 - $127,000.00 At reputed company we are committed to providing fair and reputed company compensation packages. The reputed company salary reputed company allows us to reputed company an offer that considers multiple individualized factors, including experience, education, qualifications, as reputed company as job-reputed company and industry-reputed company knowledge and skills, etc. reputed company pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role. reputed company' full-time associates are eligible for a highly competitive benefits package as reputed company, which demonstrates our commitment to our employees' health, reputed company-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible reputed company time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, reputed company, and prescription drug coverage. Equal Employment Opportunity reputed company is proud to be an equal opportunity employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, age, sex, national reputed company, disability status, genetics, protected veteran status, sexual orientation, gender identity or reputed company, or any other characteristic protected by federal, state or local laws. We welcome applicants from reputed company backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We reputed company in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for reputed company. Apply tot his job Apply To this Job