The Professional Review Nurse analyzes medical services to determine the appropriateness of charges on medical bills and reviews medical reports to assess the quality of medical care provided. Key duties involve identifying review necessity, collecting and analyzing data, and using clinical expertise to detect inappropriate billing practices and errors.
Remote Jobs & Work From Home Opportunities (207,142)
Online Course Facilitator - Dep't of Government
Eastern Kentucky University
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Full Time
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11 Weeks Ago
Eastern Kentucky University
The Online Course Facilitator supports the delivery of high-enrolled online courses by fostering regular and substantive interaction with assigned students under the direction of the Instructor of Record (IOR). This role also involves providing timely and meaningful assessment of course assignments as directed by the IOR and maintaining consistent communication and collaboration with the IOR.
The Closing Team Lead monitors and tracks all closing processes, running queries, maintaining reports, and overseeing training for new Closing Analysts. This role also involves assisting analysts with escalations, serving as final Quality Control, tracking errors, and leading meetings.
This position is responsible for all sales activities, including identifying, qualifying, developing, and closing revenue from both new customer acquisition and expansion of existing solutions focused on software and payment processing for Public Sector clients. Key duties involve generating revenue using industry expertise, developing account plans, building trusted advisor relationships, and managing sales activities within the CRM system.
The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals, aiming to support quality treatment and timely return to work. Responsibilities include providing medical case management, assessing treatment plan appropriateness, and communicating recommendations to physicians and payers.
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The Appeals Representative is tasked with reviewing, analyzing, and responding to provider inquiries and appeals received through various communication channels, ensuring adherence to regulatory guidelines and client policies. This role requires accurately setting up and efficiently initiating the appeals process in a timely manner to support overall operations.
The Medical Only Claims Specialist manages non-complex, medical-only workers’ compensation claims under close supervision, supporting departmental goals. Essential functions include receiving claims, confirming coverage, determining compensability, establishing reserves, and communicating claim status to relevant parties.
The Telehealth Billing agent is responsible for processing medical bills for various ancillary healthcare services by reviewing notes, claim forms, and authorizations to ensure alignment with diagnosis and provider recommendations. This involves applying strong data-entry skills to guarantee accurate and timely submission for provider payments and client invoicing.
The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals, aiming to support quality treatment and timely return to work. This involves assessing treatment plan appropriateness using clinical expertise and communicating directly with treating physicians to evaluate and recommend alternative care options.
The Intake Specialist provides administrative customer service by receiving and entering new ancillary healthcare referrals via telephonic and written communication. They must maintain a high focus on accuracy and urgency to quickly process service orders aligned with customer needs.
The Intake Specialist provides administrative customer service by receiving and entering new ancillary healthcare referrals via telephonic and written communication. They must maintain a high focus on accuracy and urgency to quickly process service orders aligned with customer needs.
Online Facilitator - Construction Management
Eastern Kentucky University
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Full Time
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11 Weeks Ago
Eastern Kentucky University
The Online Course Facilitator supports the delivery of high-enrolled online courses by fostering regular and substantive interaction with assigned students under the direction of the Instructor of Record (IOR). This role involves providing timely, comprehensive, and meaningful assessment of course assignments as directed by the IOR, alongside consistent communication and collaboration with the IOR.
Management Analyst 4
Arizona Department of Administration
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Full Time
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11 Weeks Ago
Arizona Department of Administration
The analyst supports the development and implementation of Value Based Purchasing (VBP) strategies and Differential Adjusted Payment initiatives by collaborating with cross-functional teams to advance payment initiatives aimed at improving health outcomes and containing costs. Major duties include supporting existing VBP initiatives, preparing necessary financial summaries and policy documentation, and engaging stakeholders to inform VBP strategies.
The Account Executive will manage the entire sales cycle for smaller accounts, from initial prospecting through closing, onboarding, and driving renewals for SaaS and mobile solutions. This role involves building strong customer relationships and ensuring clients gain maximum value before transitioning larger accounts to an Area Sales Manager.
This position supports the sales team through strategic pre-sales, functional assessment, and technical scoping activities to meet department sales targets. The role involves understanding client business challenges and technology to guide the provision of optimal solutions to both business and technical stakeholders.
WC Disability Claims Specialist II - NY Pension/ PPD
CorVel Corporation
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Full Time
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11 Weeks Ago
CorVel Corporation
The Claims Specialist manages workers’ compensation disability claims toward the best possible outcome, focusing on closure and identifying settlement opportunities through regular reviews. Essential functions include receiving claims, confirming coverage, reviewing validity, authorizing payments within limits, and ensuring timely benefit payments.
SENIOR PROPERTY AND LIABILITY CLAIMS ADJUSTER
Arizona Department of Administration
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Full Time
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11 Weeks Ago
Arizona Department of Administration
This senior role involves managing high-exposure claims and complex civil lawsuits against the State of Arizona, requiring independent investigation, accurate reserve establishment, and comprehensive settlement authority requests. The adjuster will act as a primary negotiator, represent the State in mediations, and liaise with the Attorney General’s Office to protect state interests.
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The Market Physician Executive leads the in-home multi-specialty care model, overseeing clinical strategies, policies, and daily operations, including direct patient care and supervision of clinical and operations teams. A primary focus is delivering exceptional outcomes through disease detection, evidence-based clinical pathways, and managing total cost of care and quality improvement metrics.
The Billing Specialist is responsible for completing invoicing processes for all Ancillary Healthcare services, which includes administrative review of vendor and provider bills, determining appointment types, and generating vendor payments and customer invoices with a high focus on accuracy and urgency. This role also involves providing quality and friendly inbound and outbound telephonic customer service to assist customers and vendors with billing questions.
The Claims Specialist manages lower-level, non-complex workers’ compensation claims within delegated authority, ensuring adherence to company best practices and supporting departmental goals. Key duties include confirming coverage, determining compensability, establishing reserves, authorizing payments, and communicating claim status to all relevant parties.
CA Senior Liability Claims Specialist
CorVel Corporation
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Full Time
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11 Weeks Ago
CorVel Corporation
The Senior Liability Claims Specialist manages mid to complex Auto and/or General Liability claims, focusing on achieving optimal outcomes for the company and clients. Responsibilities include receiving claims, confirming coverage, investigating, determining compensability, establishing reserves, and authorizing payments within limits.
The Medical Case Manager will provide in-person and telephonic case management to injured workers, collaborating with patients, providers, and employers to facilitate recovery. Responsibilities include assessing, planning, implementing, and evaluating patient progress while ensuring treatment plans are appropriate, medically necessary, and cost-effective.
The Scheduling Coordinator is responsible for participating in the daily operations and maintenance of the Medical Scheduling Departments, primarily by facilitating and scheduling medical services for claimants. Essential functions include proactively monitoring and managing files, identifying potential problems, proposing solutions to ensure no delay in care, and providing telephonic and written customer support.
The Scheduling Coordinator is responsible for participating in the daily operations and maintenance of the Medical Scheduling Departments, primarily by facilitating and scheduling medical services for claimants. Essential functions include proactively monitoring and managing files using proprietary web-based applications and providing telephonic and written customer support services.
The Product Support Specialist II will troubleshoot and resolve complex application issues submitted via ServiceNow, acting as a subject-matter expert for proprietary applications and ITSM processes. This involves analyzing issues for root causes, participating in post-release testing, and maintaining technical documentation.
The Claims Specialist manages lower-level, non-complex workers’ compensation claims within delegated authority, confirming coverage, determining validity, establishing reserves, and authorizing payments. They communicate claim status to customers, claimants, and clients while adhering to guidelines and assisting with more complex claims as needed.
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Senior WC Claims Specialist FLOAT (Part-time)
CorVel Corporation
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Full Time
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11 Weeks Ago
CorVel Corporation
The Senior Claims Specialist manages complex Workers' Compensation claims by confirming coverage, determining compensability through investigation, and establishing reserves and authorizing payments. This role involves developing action plans with case managers to reduce claim costs, coordinating return-to-work efforts, and managing subrogation and potential recoveries.
Business Operations
Stealth HealthTech Startup
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Full Time
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11 Weeks Ago
Stealth HealthTech Startup
The role involves leading high-priority cross-functional projects and building/improving internal operations systems to structure new healthcare groups across 50 states. Responsibilities also include identifying inefficiencies, designing scalable processes, and implementing automation to reduce manual work.
The Medical Case Manager will provide in-person and telephonic case management, working closely with injured workers, physicians, and providers to facilitate recovery. Responsibilities include assessing, planning, implementing, and evaluating patient progress, ensuring treatment plans are appropriate, medically necessary, and cost-effective.
Administrative Assistant / Data Entry Clerk (Remote Work From Home Online Telecommute) 20 APPLICANTS
Jobconversion, LLC
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Full Time
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11 Weeks Ago
Jobconversion, LLC
The primary responsibility involves performing data entry tasks accurately and efficiently from a remote location. Candidates must also be prepared to handle emailing clients as needed.
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