field reviewer

Staffing Solutions Organization LLC

<div>
 <p>
  <strong>
   Ensure Quality Care Across Illinois&mdash;One Review at a Time.
  </strong>
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Nurse Reviewer &ndash; Illinois
  </strong>
 </p>
 <p>
  <strong>
   Location:
  </strong>
  Remote with on‑site visits across Illinois
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Position Overview
  </strong>
 </p>
 <p>
  The Nurse Reviewer conducts provider compliance reviews to ensure adherence to state regulations, quality standards, and program requirements. This role includes conducting onsite visits, evaluating documentation, and determining provider compliance. The Nurse Reviewer works independently, exercises sound judgment, and provides recommendations that guide provider improvement and support statewide oversight efforts.
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Duties &amp; Responsibilities
  </strong>
 </p>
 <ul>
  <li>
   Build and maintain effective relationships with providers and users to support high‑quality customer service.
  </li>
  <li>
   Evaluate providers for compliance with applicable state and program regulations.
  </li>
  <li>
   Coordinate and schedule on‑site provider visits; clearly communicate visit requirements.
  </li>
  <li>
   Conduct compliance interviews with providers and gather all necessary information.
  </li>
  <li>
   Review provider documentation, policies, and business practices for regulatory alignment.
  </li>
  <li>
   Collect, organize, and submit documentation supporting compliance findings.
  </li>
  <li>
   Utilize technology and web‑based systems to convert paper documentation to electronic format.
  </li>
  <li>
   Conduct in‑person assessments of provider sites to evaluate compliance with oversight requirements.
  </li>
  <li>
   Summarize on‑site visit findings accurately and professionally.
  </li>
  <li>
   Exercise independent judgment to evaluate compliance and make final determinations based on documented evidence.
  </li>
  <li>
   Identify deficiencies and recommend appropriate next steps to support provider improvement.
  </li>
  <li>
   Analyze trends in non‑compliance and identify gaps in provider business processes.
  </li>
  <li>
   Provide timely recommendations and updates to the Supervisor.
  </li>
  <li>
   Maintain HIPAA standards and confidentiality at all times.
  </li>
  <li>
   Perform other duties as assigned.
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Required Skills
  </strong>
 </p>
 <ul>
  <li>
   Strong interpersonal skills with the ability to relate well to staff and providers.
  </li>
  <li>
   Active listening and effective communication skills.
  </li>
  <li>
   Proficiency in MS Word, Excel, Outlook, and web‑based applications.
  </li>
  <li>
   Process‑oriented and results‑driven work approach.
  </li>
  <li>
   Ability to foster teamwork and collaborate across levels of management and staff.
  </li>
  <li>
   Ability to work independently and within a team environment.
  </li>
  <li>
   Excellent written and verbal communication skills and customer‑service techniques.
  </li>
  <li>
   High accuracy, strong attention to detail, and commitment to quality.
  </li>
  <li>
   Proven ability to meet deadlines and follow strict standards.
  </li>
  <li>
   Ability to travel regularly to provider sites across Illinois.
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Qualifications
  </strong>
 </p>
 <p>
  <strong>
   Education
  </strong>
 </p>
 <ul>
  <li>
   Bachelor&rsquo;s degree in any field (Nursing preferred)
  </li>
 </ul>
 <p>
  <strong>
   Experience
  </strong>
 </p>
 <ul>
  <li>
   Minimum
   <strong>
    2 years of clinical experience
   </strong>
   working with critical care providers, public health providers, or providers serving children, older adults, individuals with traumatic brain injury, or individuals with developmental disabilities.
  </li>
  <li>
   Minimum
   <strong>
    1 year of experience
   </strong>
   conducting quality assurance reviews.
  </li>
 </ul>
 <p>
  <strong>
   Certification
  </strong>
 </p>
 <ul>
  <li>
   Active Illinois Registered Professional Nurse (RN) license required.
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Working Conditions
  </strong>
 </p>
 <ul>
  <li>
   Remote work with
   <strong>
    2&ndash;3 on‑site provider visits per week
   </strong>
   throughout the state of Illinois.
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Benefits (Through SSO)
  </strong>
 </p>
 <p>
  SSO offers a competitive benefits package that supports your health, financial well‑being, and long‑term growth, including:
 </p>
 <ul>
  <li>
   Medical, dental, and vision insurance
  </li>
  <li>
   401(k) with discretionary employer match
  </li>
  <li>
   Paid time off and holidays
  </li>
  <li>
   Flexible spending accounts
  </li>
  <li>
   Additional employee perks
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Keyword Search Terms
  </strong>
 </p>
 <p>
  Nurse Reviewer, RN Reviewer, Provider Management Specialist, Compliance Nurse, Healthcare Quality Review, Provider Compliance, Medicaid Compliance, Clinical Reviewer, Illinois RN, Site Visit Nurse, Healthcare Auditor, Public Health Nursing, QA Nurse, Provider Monitoring.
 </p>
</div>


Nurse Reviewer

Staffing Solutions Organization LLC (SSO)

Staffing Solutions Organization LLC (SSO), an affiliate of Public Consulting Group LLC (PCG), is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve.
<br><br>
Nurse Reviewer – Illinois
<br><b>Location:</b> Remote with on site visits across Illinois
<br><br>
Position Overview
<br>The Nurse Reviewer conducts provider compliance reviews to ensure adherence to state regulations, quality standards, and program requirements. This role includes conducting onsite visits, evaluating documentation, and determining provider compliance. The Nurse Reviewer works independently, exercises sound judgment, and provides recommendations that guide provider improvement and support statewide oversight efforts.
<br><br>
Duties & Responsibilities
<br><ul>
<li>Build and maintain effective relationships with providers and users to support high quality customer service.</li>
<li>Evaluate providers for compliance with applicable state and program regulations.</li>
<li>Coordinate and schedule on site provider visits; clearly communicate visit requirements.</li>
<li>Conduct compliance interviews with providers and gather all necessary information.</li>
<li>Review provider documentation, policies, and business practices for regulatory alignment.</li>
<li>Collect, organize, and submit documentation supporting compliance findings.</li>
<li>Utilize technology and web based systems to convert paper documentation to electronic format.</li>
<li>Conduct in person assessments of provider sites to evaluate compliance with oversight requirements.</li>
<li>Summarize on site visit findings accurately and professionally.</li>
<li>Exercise independent judgment to evaluate compliance and make final determinations based on documented evidence.</li>
<li>Identify deficiencies and recommend appropriate next steps to support provider improvement.</li>
<li>Analyze trends in non compliance and identify gaps in provider business processes.</li>
<li>Provide timely recommendations and updates to the Supervisor.</li>
<li>Maintain HIPAA standards and confidentiality at all times.</li>
<li>Perform other duties as assigned.</li>
</ul>
Required Skills
<br><ul>
<li>Strong interpersonal skills with the ability to relate well to staff and providers.</li>
<li>Active listening and effective communication skills.</li>
<li>Proficiency in MS Word, Excel, Outlook, and web based applications.</li>
<li>Process oriented and results driven work approach.</li>
<li>Ability to foster teamwork and collaborate across levels of management and staff.</li>
<li>Ability to work independently and within a team environment.</li>
<li>Excellent written and verbal communication skills and customer service techniques.</li>
<li>High accuracy, strong attention to detail, and commitment to quality.</li>
<li>Proven ability to meet deadlines and follow strict standards.</li>
<li>Ability to travel regularly to provider sites across Illinois.</li>
</ul>
Qualifications
<br>Education
<br><ul>
<li>Bachelor’s degree in any field (Nursing preferred)</li>
</ul>
Experience
<br><ul>
<li>Minimum 2 years of clinical experience working with critical care providers, public health providers, or providers serving children, older adults, individuals with traumatic brain injury, or individuals with developmental disabilities.</li>
<li>Minimum 1 year of experience conducting quality assurance reviews.</li>
</ul>
Certification
<br><ul>
<li>Active Illinois Registered Professional Nurse (RN) license required.</li>
</ul>
Working Conditions
<br><ul>
<li>Remote work with 2–3 on site provider visits per week throughout the state of Illinois.</li>
</ul>
Benefits (Through SSO)
<br>SSO offers a competitive benefits package that supports your health, financial well being, and long term growth, including:
<br><ul>
<li>Medical, dental, and vision insurance</li>
<li>401(k) with discretionary employer match</li>
<li>Paid time off and holidays</li>
<li>Flexible spending accounts</li>
<li>Additional employee perks</li>
</ul>
Keyword Search Terms
<br>Nurse Reviewer, RN Reviewer, Provider Management Specialist, Compliance Nurse, Healthcare Quality Review, Provider Compliance, Medicaid Compliance, Clinical Reviewer, Illinois RN, Site Visit Nurse, Healthcare Auditor, Public Health Nursing, QA Nurse, Provider Monitoring.
<br><br>
Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides a reasonable range of compensation for this role. In addition, SSO provides a range of benefits for this role.
<br><br>
Applicants must be authorized to work in the U.S. This position is not eligible for work authorization sponsorship (including H-1B sponsorship) by SSO and under the federal laws relating to the F-1 STEM EAD program, this position is not eligible to support a STEM EAD extension application.
<br><br>
All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability. Staffing Solutions Organization LLC is an E-Verify participant.

Oregon Health & Science University

<div>Department Overview:
<div>
The Critical Care Services Clinical Reviewer is the primary clinical reviewer for the ELSO registry as well as the Get With the Guidelines Stroke Registry, with additional abstraction duties as required by manager (i.e. supporting additional stroke abstraction per DNV requirements). Primary site abstraction is for OHSU. Duties include collecting concurrent and retrospective data, assuring integrity of the data collection and data entry for</div><div>
data submittal and data repository, reporting clinical outcomes and descriptive data, and integrating findings into quality improvement activities. The incumbent is responsible for accurate and timely collection and transmission of data in accordance with the guidelines established and performing data queries of that database</div><div>
as requested. The clinical reviewer will stay pro-actively appraised of any definitional, specification, or reporting changes and will actively collaborate with the registry and associated vendors. This position collaborates with the ECMO coordinators, ECMO and neurology faculty and staff, Stroke Program Manager, quality management staff, and other clinical reviewers. They will also participate as a member in applicable best practice and quality committee meetings.</div>
Function/Duties of Position:
<div><b>
Data Collection and abstraction</b></div><ul><li>
identifies patients for inclusion in applicable registries</li><li>
navigates the electronic medical record system, Epic, to abstract concurrent and retrospective data on all patients meeting national registry guidelines</li><li>
finds, reads, and comprehends H&amp;Ps, discharge summaries, progress notes, procedure notes, labs, medications, and outside medical records within Epic</li><li>
orders records from outside facilities when necessary in order to complete all the data collection fields</li><li>
collaborates with physicians and patient care teams to determine data needs and evaluate clinical outcomes</li><li>
monitors accuracy of data via automated and auditing means</li><li>
updates data collection tool as appropriate and in accordance with registry definitions, specifications, and guidelines</li><li>
enters accurate and complete data in a timely manner, using the approved software</li><li>
updates database software and data fields as necessary</li><li>
ensures timely data entry and submittal, integrity of data, and implementation of quality control measure to assure accuracy and validity</li><li>
develops and updates standard work tools</li><li>
exports data to registries per guidelines and in accordance with data security and integrity standards</li><li>
develops efficiencies to improve data collection processes</li><li>
works collaboratively to develop processes and ensure timely and complete collection and entry of data</li><li>
identifies issues related to documentation and works with appropriate clinicians and informatics staff to make appropriate improvements</li><li>
identifies issues potentially related to clinical practice and guideline adherence and brings those to the attention of the quality director, service line director, and appropriate medical director</li></ul><div><b>
Data Reporting and Analysis</b></div><ul><li>
distributes national benchmarking reports to customers as appropriate and as requested by medical directors, service line directors, and clinical staff</li><li>
develops and provides descriptive, statistical, and comparative analysis and reports of data as requested (analysis and reporting would include narrative, tabular, and graphical documentation and presentation)</li><li>
works closely with physician champion, other clinical staff, supervisor, quality management staff, and hospital staff to identify opportunities for improvement</li><li>
develops and reports standardized queries, reports, and dashboards on a quarterly basis and additional queries as requested</li><li>
prepares and presents comprehensive reports to appropriate committees, management, and other audiences within defined timeframes</li><li>
establishes effective working relationships with medical and service line leadership for reliable and meaningful data interpretation and analysis</li><li>
coordinates data inquiries to promote research activities as requested</li><li>
actively participates in accreditation visits and preparation, and provides clinical outcome and performance improvement data as required</li><li>
prepares presentations / documentation and helps present during survey visits</li><li>
presents data to DNV during onsite and intracycle visits</li></ul><div><b>
Communication and software maintenance</b></div><ul><li>
collaborates with appropriate ITG staff to address software related issues and upgrades</li><li>
acts as primary liaison with ELSO and GWTG-Stroke, and any other registries as assigned by manager</li><li>
coordinates discussions with ITG on database-related interfaces
</li><li>communicates openly and effectively with certified software vendors
</li><li>works collaboratively with vendors to troubleshoot any database and software-related issues</li><li>
communicates with database registry staff</li><li>
keeps apprised of applicable changes
</li><li>briefs and updates cardiovascular service line and quality management staff as appropriate</li></ul><div><b>
Other Duties as Assigned</b></div>
Required Qualifications:
<ul><li><div>
A Bachelor&rsquo;s degree in finance, business management or related field; <b>AND</b></div></li><li><div>
Two years of industry related experience that includes project management, financial accounting, management reporting and analysis of specialized work processes standards, regulations; statistics or quantitative analysis methods and procedures, <b>OR</b></div></li><li><div>
An equivalent combination of education, training and/or experience.</div></li></ul><div><b>
Job Related Knowledge, Skills and Abilities (Competencies):</b></div><ul><li>
Experience in hospital department, clinic, patient care unit, clinical research, or medical record reviewer</li><li>
Clinical chart review and abstraction experience or experience in medical database entry
</li><li>Experience working with national registries or databases</li><li>
Proficient computer skills including the use of MS Office products, basic statistical skills, and the internet.
</li><li>Experience with relational databases and data quality methods
</li><li>Clinical knowledge and understanding of patient care.</li><li>
Experience in clinical chart review and abstraction.
</li><li>Excellent verbal and written communication skills.</li><li>
Must be able to perform the essential functions of the position with or without accommodation<br>
</li></ul>
Preferred Qualifications:
<ul><li>Degree in healthcare related field preferred</li><li>
clinical data collection experience
</li><li>experience with the heart failure patient population</li><li>
Access and Excel proficiency
</li><li>Quality improvement and patient safety knowledge and experience</li><li>
Advanced statistic knowledge and experience</li></ul>
Why apply to OHSU?: <b>We are Oregon's only public academic health center.</b> In addition to caring for patients, we lead groundbreaking research. We also train the next generation of health care professionals. As Portland's largest employer, we give you opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington. <b>All are welcome.</b> OHSU welcomes people of all ages, ethnicities, genders, national origins, religions and sexual orientations. We are striving to build an anti-racist, multicultural institution and encourage people with diverse backgrounds to apply. To request reasonable accommodation, contact askhr@ohsu.edu</div>

Critical Care Services Clinical Reviewer (Business Data Analyst 3)

Liberty Healthcare Corporation

<div><p>Registered Nurses are encouraged to consider a full-time Clinical Reviewer position with Liberty Healthcare.</p>
<p>
As a Clinical Reviewer, you will be an active contributor with a large-scale program which endeavors to enrich the lives of older adults and people who are living with developmental disabilities.</p>
<p>
Your role will focus on the review and analysis of health information of recipients of Medicaid HCBS waiver services, and your day-to-day responsibilities will include:</p>
<ul>
<li>Reviewing medical records and personal health information</li>
</ul><ul><li>Conducting root cause analyses of critical incidents and deaths</li>
</ul><ul><li>Forming objective evidence-based opinions</li>
</ul><ul><li>Writing detailed reports</li>
</ul><ul><li>Leading and participating in committee and team meetings</li>
</ul><ul><li>Providing technical assistance and training</li>
</ul><ul><li>Collaborating with stakeholders</li>
</ul>
<p>This is a remote-first position which will primarily allow you to work in your home office with an occasional need to attend in-person meetings in Nebraska. This is a non-direct care role which does not involve patient contact or nursing care.</p>
<p>
As a valued full-time employee of Liberty Healthcare and Clinical Reviewer, you can expect:</p>
<ul>
<li>$80,000 annual salary</li>
</ul><ul><li>Health insurance, dental insurance, vision insurance, life insurance, and disability insurance</li>
</ul><ul><li>30 days of paid time off each year for holidays, vacation, sick leave, and personal days</li>
</ul><ul><li>Health Savings Account, 401k plan, and other perks</li>
</ul>
<p>Full details on Liberty's benefits plan are available at www.libertyhealthcare.com/upload/138.pdf</p>
<p>You are a good fit for this position if you possess the following:</p>
<ul>
<li>Professionally licensed as a Registered Nurse in Nebraska</li>
</ul><ul><li>Experience providing nursing services to older adults and people who are living with developmental disabilities</li>
</ul><ul><li>Knowledge of quality assurance methodologies
</li></ul><ul><li>Outstanding analytical and report writing skills</li>
</ul><ul><li>Nebraska residency</li>
</ul>
<p>Liberty Healthcare is an equal opportunity employer committed to diversity, equity, and inclusion. Our organization is composed of, and proudly serves, people of diverse backgrounds and abilities.</p>
<p>
Click &ldquo;Apply&rdquo; and submit your resume for immediate consideration.</p></div>

Registered Nurse – Clinical Reviewer

MCMC

<div><div><div><b>Ready for a Rewarding Career that Fits Your Lifestyle?</b>
</div></div><p></p><div><div>Imagine a job where you can keep your <b>clinical skills sharp</b>, tackle exciting challenges, AND work from the comfort of your own home. Sounds like the perfect mix, right?</div></div><p>
</p><p></p><div><div><b>MES</b> is looking for a <b>self-driven, high-performing Registered Nurse (RN) or Licensed Vocational Nurse (LVN)</b> to join our dynamic team as a <b>Clinical Quality Assurance Coordinator</b>. In this role, you&rsquo;ll ensure our <b>Peer Review case reports</b> are nothing short of exceptional&mdash;delivering top-notch quality and integrity, all while staying fully aligned with <b>client agreements</b>, <b>regulatory standards</b>, and <b>state and federal mandates</b>.</div></div><p>
</p><div><div>The position is <b>100% remote</b> with a schedule of<b> </b><b>Monday through Friday:</b></div></div><ul><li><div><b>
three days: 12-8:30PM EST
</b></div></li><li><div><b>two days: 8-4:30PM EST</b></div></li></ul><p>
</p><ul><li><div>Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.</div></li><li><div>
Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.</div></li><li><div>
Ensures that all client instructions and specifications have been followed and that all questions have been addressed.</div></li><li><div>
Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.</div></li><li><div>
Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.</div></li><li><div>
Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.</div></li><li><div>
Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.</div></li><li><div>
Ensures the provider credentials and signature are adhered to the final report.</div></li><li><div>
Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.</div></li><li><div>
Assists in resolution of customer complaints and quality assurance issues as needed.</div></li><li><div>
Ensures all federal ERISA and/or state mandates are adhered to at all times.</div></li><li><div>
Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.</div></li><li><div>
Promote effective and efficient utilization of company resources.</div></li><li><div>
Participate in various educational and or training activities as required.</div></li><li><div>
Perform other duties as assigned.</div></li></ul><p>
</p><div></div><div><div>If you&rsquo;re ready to make a real impact in healthcare, all while enjoying the flexibility of working remotely, we want to hear from you!
</div></div><p></p><ul><li><div>Active RN/LVN nursing license required.</div></li><li><div>
Must be a graduate of an accredited nursing program or related medical experience; bachelor's degree preferred.</div></li><li><div>
A minimum of two years clinical or related field experience; or equivalent combination of education and experience.
</div></li><li><div>Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.</div></li><li><div>
Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.</div></li><li><div>
Must be a qualified typist with a minimum of 40 W.P.M</div></li><li><div>
Must be able to operate a general computer, fax, copier, scanner, and telephone.</div></li><li><div>
Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.</div></li><li><div>
Must possess excellent skills in English usage, grammar, punctuation and style.</div></li><li><div>
Ability to follow instructions and respond to upper managements&rsquo; directions accurately.</div></li><li><div>
Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.</div></li><li><div>
Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.</div></li><li><div>
Must be able to work independently, prioritize work activities and use time efficiently.</div></li><li><div>
Must be able to maintain confidentiality.</div></li></ul><p>
</p><p></p><div><div><b>MES Solutions</b> is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our credentialed medical panel conduct physical examinations or medical record reviews, delivering reports that assist clients in the resolution of automotive, disability, liability, and workers' compensation claims. MES has been providing services nationally since 1978 in accordance with the industry's highest standards of operating excellence and regulatory compliance.</div></div><p>
</p><p></p><div><div>Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.</div></div><div><div><b>
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans</b></div></div><div><div><b><i>
MES offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.</i></b></div></div></div>

Clinical Quality Assurance Coordinator

TEEMA

<div><p><b>Claims Reviewer Opportunity</b></p><p>
Join a dynamic team where your expertise in claims review can make a real difference! We're looking for a detail-oriented Claims Reviewer who can apply clinical and coding knowledge to ensure accurate claims processing. If you have a strong foundation in medical claims and are passionate about quality, we want to hear from you!</p><p><b>
Position Highlights</b></p><ul><li><p><b>
Role</b>: Conduct retrospective review of medical, surgical, and behavioral health claims.</p></li><li><p><b>
Focus</b>: Evaluate claims for medical necessity, appropriateness, and adherence to program benefits.</p></li><li><p><b>
Collaboration</b>: Work closely with medical directors, providers, peer reviewers, and various internal teams.</p></li></ul><p><b>
Key Responsibilities</b></p><ul><li><p>
Review and validate claims using established criteria and processing guidelines.</p></li><li><p>
Prepare cases for payment or further review.</p></li><li><p>
Identify opportunities for process improvement and flag quality or fraud concerns.</p></li><li><p>
Support peers and clinical/non-clinical staff with claims and coding inquiries.</p></li></ul><p><b>
What You Bring</b></p><ul><li><p><b>
Required</b>:</p><ul><li><p>
High School Diploma or GED.</p></li><li><p>
2+ years of experience in medical claims review.</p></li><li><p>
Familiarity with medical claims processing and terminology.</p></li></ul></li><li><p><b>
Preferred</b>:</p><ul><li><p>
Coding experience.</p></li><li><p>
Knowledge of behavioral health claims.</p></li></ul></li></ul><p><b>
Skills for Success</b></p><ul><li><p>
Strong technical skills in claims tools (e.g., CDST, Supercoder).</p></li><li><p>
Organizational and team-building abilities.</p></li><li><p>
Resilience in a fast-paced, high-intensity environment.</p></li><li><p>
Effective communication and problem-solving.</p></li></ul><p><b>
Additional Requirements</b></p><ul><li><p>
Must pass background, credit, and drug screening.</p></li><li><p>
Adherence to federal THC policies (medical card required if applicable).</p></li></ul><p><b>
Eligible Locations</b><br>
The position is remote, but you can only reside in the following states: AK, AR, AZ, CO, DC, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NC, ND, NE, NM, NV, OK, OR, SC, SD, TN, TX, UT, VA, WA, WI, WY.</p><p>
Ready to bring your claims expertise to a rewarding role? Apply today to be part of our team!</p>
#Workwolf #BCDC_Consulting</div>

Claims Reviewer

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