Initiating and conducting claims investigation in a timely manner. Managing medical treatment and medical billing, authorizing as appropriate. Skills and Requirements Include: 1 to 5 years related experience. Technical knowledge of statutory regulations and medical terminology.
Strong clinical skills. Strong computer and keyboarding skills (Microsoft Outlook and Word) Ability to comprehend medical policy and criteria to clearly articulate health information. Experience with UM processes in accordance to URAC and NCQA.
Design and perform actuarial studies related to medical care costs and trends. Extract and compile information from various systems to support executive decision-making. Applicants must meet the following qualifications: Bachelor's Degree in Mathematics, Statistics, or Economics.
Performing clinical/medical reviews of previously denied cases. Identifying and reporting quality of care issues. Qualifications Include: Graduated from an Accredited School of Nursing. 3-5 years clinical nursing experience. 1-3 years Managed Care Experience.
Required Skills: Ability to travel to attend and monitor trials in the North New Jersey region as needed. Bachelor's Degree. Thorough knowledge of medical liability claims. Knowledge of policy coverage provisions and issues is essential.
A clinical documentation company is filling a position for a Telecommuting Precertification Medical Specialist. Must be able to: Call to obtain insurance authorizations for medical procedures.
Ability to present issues, lead and/or participate in discussions and develop conclusions with internal and external medical professionals and other experts. Demonstrated analytical ability to identify problems, develop solutions and implement a chosen course of action.
Bachelor's Degree or 1 to 2 years of equivalent business, contracting, customer relations experience. One or two years experience in a medical environment dealing with managed care or insurance issues. Strong written communication. Strong PC skills, including business software.