Conduct pre- and post-payment medical reviews to ensure compliance with clinical criteria and guidelines. Assess medical necessity and reimbursement eligibility for complex claims, appeals, and fraud referrals.
Broadway Ventures
12 Remote Job Openings at Broadway Ventures
Conduct pre- and post-payment medical reviews to ensure compliance with clinical criteria and reimbursement eligibility. Document rationales for service approvals or denials and provide guidance to LPN and non-clinical staff.
Manage the accuracy and timeliness of Medicare cost report acceptance and settlements within the Fiscal Intermediary Shared Systems (FISS). Collaborate with internal departments and providers to resolve reimbursement issues and ensure proper healthcare funding.
Perform entry-by-entry compliance reviews of TEFCA directory records using documented protocols and authoritative reference sources. Document findings and dispositions in Jira while maintaining a complete audit trail for federal health IT program reporting.
Hematology/Oncology, Physician Medical Case Reviewer (Remote, Part-Time, Flexible Hours)
Broadway Ventures
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Full Time
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a month ago
Broadway Ventures
Conduct objective medical case audits and quality reviews for the Department of Veterans Affairs to assess care appropriateness. Provide expert medical advisory opinions and identify opportunities for performance improvement based on clinical best practices.
Remote Home Health RN – Medical Claims Reviewer
Broadway Ventures
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Full Time
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a month ago
Broadway Ventures
The role involves conducting pre- and post-payment medical reviews to ensure compliance with clinical criteria and guidelines. Responsibilities include reviewing claims, assessing payment determinations, and providing guidance to team members.
Nephrology Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)
Broadway Ventures
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Full Time
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2 months ago
Broadway Ventures
Conduct independent medical case reviews and audits for the Department of Veterans Affairs to assess quality of care and adherence to standards. Provide expert medical advisory opinions and identify opportunities for performance improvement.
Gastroenterology Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)
Broadway Ventures
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Full Time
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2 months ago
Broadway Ventures
Conduct independent medical case reviews for the Department of Veterans Affairs to assess quality of care and adherence to standards. Provide expert medical advisory opinions and identify opportunities for performance improvement.
Surgical Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)
Broadway Ventures
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Full Time
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2 months ago
Broadway Ventures
Conduct independent medical case reviews and audits for the Department of Veterans Affairs to assess quality of care and adherence to standards. Provide expert medical advisory opinions and identify opportunities for performance improvement.
Cardiology Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)
Broadway Ventures
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Full Time
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2 months ago
Broadway Ventures
Conduct independent medical case reviews and audits for the Department of Veterans Affairs to assess quality of care and adherence to standards. Provide expert medical advisory opinions and identify opportunities for performance improvement based on evidence-based perspectives.
Radiology Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)
Broadway Ventures
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Full Time
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2 months ago
Broadway Ventures
Conduct independent medical case reviews and audits for the Department of Veterans Affairs to assess quality of care and adherence to standards. Provide expert medical advisory opinions and identify opportunities for performance improvement.
Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)
Broadway Ventures
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Full Time
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5 months ago
Broadway Ventures
The physician will conduct independent medical case reviews to assess quality of care and adherence to standards. They will also provide expert medical opinions and identify opportunities for improvement.
