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... related issues which may include claims inquiries, enrollment issues, travel attestations, ... Manual (TRM), and the TRICARE Policy Manual (TPM). Assist with questions ... with qualifying ASD diagnoses. Provide..
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Description Responsibilities The Compliance Professional 2 has responsibilities for performing clinical ... the Autism Care Demonstration (ACD) policy, TRICARE Operations Manual (TOM) Chapter ... session notes to the provider's claims..
Description The Pharmacy Claims Lead operationalizes and monitors Coordination ... Cultural Competency Enable personal & professional growth Develop analytics and reporting ... business Actively identifies and owns process improvements and..
Description The Senior Market Development Professional provides support to assigned health ... support. The Senior Market Development Professional work assignments involve moderately complex ... Responsibilities The Senior Market Development Professional..
Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..
... The Senior Fraud and Waste Professional conducts investigations of allegations of ... The Senior Fraud and Waste Professional work assignments involve moderately complex ... The Senior Fraud and Waste..
Description The Senior Health Information Management Professional work assignments involve moderately complex to complex issues to work with various teams to develop business requirements, track and monitor the success of the ..
... Medical Coding Auditor reviews medical claims submitted against medical records provided, ... systems, and by ensuring correct claims payment and appropriate CPT/ HCPCS ... Medical Coding Auditor reviews medical..
... Senior Clinical Strategy and Practice Professional builds strategies for development, engagement, ... Senior Clinical Strategy and Practice Professional work assignments involve moderately complex ... Responsibilities The Senior Behavioral Health..
Description The Medical Director's primary responsibility is the review of medical authorizations or claims to determine the medical necessity of a given service or level of care. The Medical Director's work ..
... The Senior Fraud and Waste Professional conducts investigations of allegations of ... The Senior Fraud and Waste Professional work assignments involve moderately complex ... Knowledge of healthcare payment methodologies,..
Description The Nurse Auditor 2 will work on the clinical ... audit concepts. The Nurse Auditor 2 will perform clinical audit and ... and abuse. The Nurse Auditor 2 work..
Description Job Description Summary The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations ..
Description The Health Information Management Professional ensures data integrity for claims errors. The Health Information Management ... errors. The Health Information Management Professional work assignments are varied and ... Responsibilities..
... well-being. We also provide excellent professional development & continued education. Required ... direct reports Prior health insurance claims experience Excellent PC skills (including ... or religious exemption consideration. This..
... systems, and by ensuring correct claims payment and appropriate diagnosis related ... well-being. We also provide excellent professional development & continued education. This ... work experience reading and interpreting..
Description The Medical Coding Coordinator 2 extracts clinical information from a ... records. The Medical Coding Coordinator 2 performs varied activities and moderately ... Responsibilities The Medical Coding Coordinator 2..
Job Information Humana UM Medical Director - Conviva in Montpelier Vermont Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex ..
... is a dispute on adjudicated claims that contain a code editing ... well-being. We also provide excellent professional development & continued education. Required ... Certification (no apprentice) Minimum of..
