204 bill review analyst ii jobs found

The Payment Integrity Analyst (Team Lead) assists with leading the Policy and Payment Integrity (PPI) team while maintaining the regular duties and responsibilities of this role which is accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. The Team Lead must also be knowledgeable of the application of client policy and industry standards within reviews conducted by CERIS including but not limited to itemized bill review, professional review, hospital outpatient; trend analysis of internal auditing, appeals of pre and post payment claims, and any other claim or record that requires quality review to determine claim accuracy; assist with development of internal quality assurance measures based on client policy and industry guidelines; perform quality assurance reviews; assist in researching and implementing best practices related to payment policy, and/or policy initiatives; researching various healthcare policies....

The Payment Integrity Analyst (Team Lead) assists with leading the Policy and Payment Integrity (PPI) team while maintaining the regular duties and responsibilities of this role which is accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. The Team Lead must also be knowledgeable of the application of client policy and industry standards within reviews conducted by CERIS including but not limited to itemized bill review, professional review, hospital outpatient; trend analysis of internal auditing, appeals of pre and post payment claims, and any other claim or record that requires quality review to determine claim accuracy; assist with development of internal quality assurance measures based on client policy and industry guidelines; perform quality assurance reviews; assist in researching and implementing best practices related to payment policy, and/or policy initiatives; researching various healthcare policies....

CorVel is hiring a Medical Bill Review Analyst. The Bill Review Analyst is responsible for review, auditing and data-entry of medical bills for multiple states and lines of business.  This is a remote role. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines and PPO discounts.  Position requires knowledge of the Fee Schedule and the operation of the computer terminal May consult reference materials in the auditing process Requires regular and consistent attendance. Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP). Additional duties as assigned.   PRODUCTION REQUIREMENTS: Based upon situation or state specific issues meet 98% accuracy, 10,000+ keystrokes per hour   KNOWLEDGE & SKILLS: Knowledge of medical terminology, workers’...

The Bill Review Analyst is responsible for reviewing, auditing and data-entry of medical bills for multiple states and lines of business.  This is a hybrid role. Training is onsite Full Time, then Hybrid once trained. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines, and PPO discounts May consult reference materials in the auditing process Based upon situation or state-specific cases, meet 98% accuracy, 10,000+ keystrokes per hour Additional duties as assigned   KNOWLEDGE & SKILLS: Knowledge of medical terminology, workers’ compensation billing guidelines and fee schedules Knowledge of CPT/ICD/HCPS coding Knowledge of UBO4/DWC-9/DWC-10 and CMS 1500 form types preferred Strong interpersonal skills and commitment to customer service Ability to work independently...

The Procurement Analyst plays a critical role in supporting Enhanced Bill Review Programs by securing essential medical documentation, including itemizations and medical records needed to process claims accurately and efficiently. This position involves proactive outreach to providers, managing inbound inquiries, and ensuring all documentation meets quality and compliance standards, including HIPAA regulations. The Procurement Analyst is detail-oriented, organized, and thrives in a fast-paced environment where meeting production goals and collaborating with team members are key to success. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Spend approximately 80-85% of the shift making outbound calls to providers to obtain required information; may also send email or fax requests Respond to inbound calls regarding claim status and related inquiries Maintain accurate records of all communications between the company, providers, and...

The Procurement Analyst plays a critical role in supporting Enhanced Bill Review Programs by securing essential medical documentation, including itemizations and medical records needed to process claims accurately and efficiently. This position involves proactive outreach to providers, managing inbound inquiries, and ensuring all documentation meets quality and compliance standards, including HIPAA regulations. The Procurement Analyst is detail-oriented, organized, and thrives in a fast-paced environment where meeting production goals and collaborating with team members are key to success. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Spend approximately 80-85% of the shift making outbound calls to providers to obtain required information; may also send email or fax requests Respond to inbound calls regarding claim status and related inquiries Maintain accurate records of all communications between the company, providers, and...

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication Use clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits Utilize applicable tools and resources to complete internal audits and/or appeals Timely completion of internal audits and/or appeals Attends clinical team meetings, company meetings, educational opportunities/trainings, and other meetings Additional duties as assigned   KNOWLEDGE & SKILLS: Ability to use clinical judgment and analytical skills for...

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication Use clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits Utilize applicable tools and resources to complete internal audits and/or appeals Timely completion of internal audits and/or appeals Attends clinical team meetings, company meetings, educational opportunities/trainings, and other meetings Additional duties as assigned   KNOWLEDGE & SKILLS: Ability to use clinical judgment and...

The Data Verification Analyst is responsible for all bill review clerical functions, including mail, prepping and scanning medical bills, data entry, data verification and assisting with various phone and email tasks to support the bill review department. This is a hybrid role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Validate incoming data to the Bill Review system Identify and apply customer-specific rules and processes Requires continual and consistent communication with supervisor regarding status of Data Verification queues and workload Assist the bill review department with all clerical duties as assigned Additional duties as assigned   KNOWLEDGE & SKILLS: Ability to work on several concurrent tasks and prioritize workload with minimal direction Ability to identify, analyze and solve problems Basic computer proficiency, including familiarity with Microsoft Office applications Strong interpersonal, time management, and organizational...

The Capture Center Specialist participates in all assigned activities pertaining to scanning, matching and attaching EOR and bill to be returned to the client and responding to phone calls from the providers. The participant will handle all incoming mail and faxes. The participant is also responsible for making sure that the bills are returned to the client within a timely manner and understanding how to communicate with the supervisor any delays that would prevent the work from being returned in a timely manner. The participants are responsible for working as a team and assisting each other when required to make sure the goals are met or achieved. To successfully accomplish these responsibilities the Capture Center Specialist will work closely with the analyst and supervisor. This is an onsite role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identifying and indexing all incoming faxes to the appropriate file, on a daily and timely basis Scans paper documents and...

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity As a dedicated Bank Credit Risk Analyst, you will use quantitative methods to identify credit risk, develop and deliver credit strategies, and monitor credit performance for consumer credit portfolios to optimize profitable growth within risk appetite. Mitigate operational and compliance risk inherent in credit strategy. Track...

The Company At Utica National Insurance Group, 1,400 employees countrywide take our corporate promise to heart every day: To make people feel secure, appreciated, and respected. Utica National Insurance Group is an "A" rated $2.0B award-winning, nationally recognized property & casualty insurance carrier. Operating along the Eastern half of the United States, based in our Home Office in Central New York, with Regional Office locations including NYC, Dallas and Charlotte. Our Mission  is to continually meet the needs of our policyholders, agent/customers and employees resulting in sustainable profitable growth in an increasingly competitive marketplace. We are proud to sell our products through more than 2,200 independent insurance agents around the country as we have been since 1928. These agents provide their clients with valuable insight and resources. And, as the second-largest insurer of  Agents’ Errors and Omissions  (E&O) business in the United States,...

The WC Senior Claims Specialist handles complex and high-profile Workers' Compensation claims following company standards. This role works closely with case managers and attorneys, manages subrogation, and negotiates settlements. The Senior Claims Specialist ensures the best possible outcome for the claim, meeting customer service expectations, and supporting the goals of the Claims Department and CorVel. This is a temporary, remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives   Workers’ Compensation  claim, confirms policy coverage and acknowledgement of the claim Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies Establishes reserves and authorizes payments within reserving authority limits Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim...

The Qualified Rehabilitation Consultant (QRC)/Vocational Case Manager provides vocational rehabilitation services and medical case management to individuals following a work place injury through coordination with client, insurer, physician, employer, attorney and others with the ultimate goal being the client’s timely return to gainful employment. The Vocational Case Manager interviews and evaluates the client to determine the degree of disability, eligibility and feasibility of vocational rehabilitation services. This position determines suitable job goals consistent with the clients’ interests, aptitudes and physical limitations; supporting the goals of the Case Management department, and of CorVel. Candidates with case management experience or vocational rehabilitation background encouraged to apply This is a Minnesota Field Case Management position. Only MN candidates will be considered. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Schedule and carry out appointments...

This is your opportunity to join AXIS Capital – a trusted global provider of specialty lines insurance and reinsurance.  We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders. We also proudly maintain an entrepreneurial, disciplined and ethical corporate culture.  As a member of AXIS, you join a team that is among the best in the industry. At AXIS, we believe that we are only as strong as our people. We strive to create an inclusive and welcoming culture where employees of all backgrounds and from all walks of life feel comfortable and empowered to be themselves. This means that we bring our whole selves to work.  All qualified applicants will receive consideration for employment without regard to any protected characteristic, including age, color, disability, ethnicity, gender identity, marital status, national origin, pregnancy, race, religion, sex, sexual orientation, veteran status, or...

Department Summary:  The position partners closely with cybersecurity teams, business units, privacy, legal, compliance, audit, and technology organizations to identify, assess, monitor, and reduce data-related risks across cloud, SaaS, endpoint, collaboration, and on-premises environments while enabling business objectives and regulatory compliance. The position also will be critical to review and update our Security posture from a Data Security and Data Loss Prevention as we expand our AI build and capabilities.  Position Summary The Information Security Specialist II – Data Security (DSPM & Data Loss Prevention) serves as a senior subject matter expert responsible for the design, implementation, governance, and continuous improvement of the enterprise Data Security Program. This role provides strategic and technical leadership for Data Security Posture Management (DSPM), Data Loss Prevention (DLP), Data Classification, Information and Data Protection, Insider...

We have an exciting opportunity for a Senior Advisor within our Executive Advisory Services team focused on the Managed Care space. This highly visible role operates at the intersection of data, strategy, and executive advisory, helping clients identify opportunities to improve program performance, reduce total cost of risk, and enhance outcomes through data-driven decision making. The Senior Advisor serves as a trusted advisor to clients and internal stakeholders, leveraging analytics, industry benchmarking, market intelligence, and emerging technologies to develop executive-level assessments, identify performance gaps, and deliver executive-ready actionable recommendations. This role requires an individual who is comfortable analyzing complex and large amounts of data, succinctly presenting findings to executive audiences, and identifying innovative solutions that address evolving client needs. As a key member of the Executive Advisory Services team, this position partners...

National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers’ evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.  Job Description The Claims Inside Auto Trainee Analyst II is responsible for investigating and confirming the facts of loss for automobile accidents. This role determines coverage, liability, damages and otherwise adjusts and negotiates claims within authority. ** We are seeking motivated individuals to begin a rewarding career in the insurance industry as Claims Adjuster Trainees! In this role, you’ll be responsible for investigating and verifying the details of automobile accidents, including obtaining police reports, collecting witness statements, confirming coverage, and determining liability. The ideal...

ABOUT HUB: In a rapidly changing world, HUB advises businesses and individuals on how to prepare for the unexpected. As one of the worlds' largest insurance brokers, our focus is dedicated to providing our customers with the peace of mind that what matters most will be protected-through unrelenting advocacy and tailored insurance solutions that put our clients in control. Our growing team of professionals across North America represents a broad, deep and one-of -a kind aggregation of entrepreneurs and leaders recognized for their excellence throughout the insurance community. THE OPPORTUNITY: The Account Manager II manages a more complex or specialized book of insurance business, and provides professional, courteous service to clients, carrier representatives, underwriters, business partners, and HUB colleagues. They may work independently, as part of a team or with a Producer to provide client advocacy, client retention, write new client accounts or lines of coverage as...

ABOUT HUB: In a rapidly changing world, HUB advises businesses and individuals on how to prepare for the unexpected. As one of the worlds' largest insurance brokers, our focus is dedicated to providing our customers with the peace of mind that what matters most will be protected-through unrelenting advocacy and tailored insurance solutions that put our clients in control. Our growing team of professionals across North America represents a broad, deep and one-of -a kind aggregation of entrepreneurs and leaders recognized for their excellence throughout the insurance community. THE OPPORTUNITY: The Account Manager II manages a book of insurance business, and provides professional, courteous service to clients, carrier representatives, underwriters, business partners, and HUB colleagues; manages complex risk and exposures and acts with a high degree of independent discretion, autonomy, and decision-making. The Account Manager II also supports Producers and other support...