Medical Necessity Review Specialist

Job Title: Peer Review Specialist">About the Role:We are seeking a highly skilled and detail-oriented professional to support our Residential, PHP, and IOP levels of care.This individual will be responsible for conducting peer reviews, case consultations, and interfacing with insurance payers to obtain continued authorization.The ideal candidate will be a...

This Medical Billing role involves assisting in meeting responsibilities in a timely and accurate fashion.Responsibilities:Review appeals for medical necessityFax appeals to the appropriate partySet reminders to follow up after the appeal is sent to ensure it has been receivedFollow up again closer to the timeframe for determination; update...

Job Title: Healthcare SpecialistA clinical review nurse is responsible for conducting thorough assessments of medical cases to ensure they meet the necessary criteria.This involves performing clinical intake and adjudicating (closing) cases, as well as requesting additional information or escalating to medical directors as needed.

Job Title: Healthcare Utilization SpecialistThe Role:As a Healthcare Utilization Specialist, you will be responsible for assessing and interpreting customer needs, requirements, and medical records.Responsibilities:Review medical claims for medical necessityAssess and interpret customer needs, requirements, and medical recordsQualifications:Active PHRN and...

This is a Medical Reviewer position with a remote work opportunity.The ideal candidate will have a BSN degree and an active PHRN license. Good communication skills are essential to assist veterans, medical providers, and colleagues effectively.This role requires minimal supervision and flexibility in work schedule changes. The candidate must take...

Medical Coding SpecialistThe Medical Coding Specialist will be responsible for conducting thorough research and analysis of Medicare, Medicaid, and other medical coding documents to identify claim denial or covered criteria. This role involves providing written and oral presentations to clinical colleagues to obtain consensus on proposed denial criteria.This...

Limitlessli specializes in recruiting and managing high-caliber remote staff for dynamic healthcare facilities.The OpportunityWe seek a skilled Medical Reviewer with expertise in wound care. This role involves managing patient wound care records, verifying insurance eligibility, and coordinating essential medical supplies.This position is remote and offers...

Medical Coding SpecialistThe professional in this role functions under the direction of a coding director and is responsible for assigning medical codes by abstracting and reviewing medical documentation according to established coding guidelines, payer guidance, and government regulations. This specialist must possess a high level of integrity, requiring a...

Job Opportunity: Medical Compliance SpecialistWe are seeking a detail-oriented and organized individual to assist our Compliance team in maintaining the most current laws, procedures, and guidelines for all assigned states. This role requires strong research skills, excellent verbal and written communication, and the ability to plan and prioritize tasks to...

Job Title: Medical Coding SpecialistWe are seeking a skilled Certified Medical Biller and Coder to excel in accurate and timely submission of medical claims, optimizing revenue cycles while maintaining compliance with regulatory standards.Key Responsibilities:Analyze and abstract medical information from patient records for physician/NP visits and home...