The Closing Analyst is responsible for closing client files and applying results into Scheck and CareMC systems. They must ensure all documentation is attached and follow departmental quality control protocols.
CERIS
46 Remote Job Openings at CERIS
Supports the Setup Supervisor in managing the Setup Team and ensuring protocol adherence while maintaining a personal production quota. Acts as a liaison between analysts and clients and provides guidance and training to team members.
The role involves reviewing and analyzing provider inquiries and appeals via various communication channels. It ensures appeals are set up accurately and timely in accordance with regulatory and client guidelines.
Review and analyze provider inquiries and appeals via various communication channels in accordance with regulatory and client guidelines. Ensure all appeals are accurately set up and initiated in a timely manner to support efficient processing.
The analyst is responsible for conducting pre- and post-pay claim audits based on client policies, industry standards, and CMS guidelines. This includes reviewing itemized bills and DRGs while providing professional written communication for audits and appeals.
The Itemization Review Nurse analyzes charges on UBIB submissions from medical facilities to ensure billing accuracy. They document final conclusions in a designated computer program and provide summaries of billed items.
The analyst is responsible for reviewing and monitoring repricing audit data to ensure accuracy, compliance, and efficiency across multiple platforms. They will develop QA policies, investigate discrepancies, and collaborate with stakeholders to improve operational effectiveness.
The Recovery Supervisor manages staff and monitors claims audit data to ensure timely and accurate processing of internal and external requests. They are responsible for improving department activities, reducing response times, and analyzing revenue cycle transactions to ensure data integrity.
Review and analyze provider inquiries and appeals via multiple communication channels in accordance with regulatory and client guidelines. Ensure all appeals are accurately set up and initiated in a timely manner to support efficient processing.
The Quality Control Nurse ensures the integrity of the MCS Bill Review database by analyzing hospital billing itemization and verifying data sets for accuracy. They maintain constant communication with Data Entry and Medical Review departments to resolve billing errors and ensure production standards are met.
The role involves reverse coding medical bills to ensure accuracy and making claim-related recommendations to stakeholders. Responsibilities include processing claims based on state regulations and maintaining HIPAA compliance.
The specialist analyzes and monitors claims audit data to ensure accurate reimbursement according to contractual agreements. They identify payment variances and work internally and externally to resolve billing errors and overpayments.
Oversees department operations including personnel hiring, quality assurance, and staff accountability to meet production standards. Collaborates with other managers to ensure timely communication and compliance with client SLAs and department metrics.
The Itemization Review Nurse analyzes medical facility billing charges to ensure accuracy against submitted documentation. They are responsible for documenting conclusions in the system and maintaining compliance with department standards.
The Setup Team Lead supports the supervisor in managing team protocols, performing supervisory duties, and maintaining production quotas. They act as a liaison between analysts and clients while training new employees and ensuring HIPAA compliance.
The Procurement Coordinator is responsible for distributing claims to analysts and tracking volume to ensure consistent workflow. They also perform quality control reviews on all outgoing and incoming files to ensure completeness and accuracy.
The Director of Implementations provides strategic leadership for client programs, overseeing the entire implementation lifecycle from prospect presentation to operational transition. They are responsible for managing cross-functional teams, enforcing implementation standards, and driving continuous process improvement across the organization.
The Clinical Auditor performs DRG validation reviews of medical records to ensure billing accuracy and compliance with regulatory standards. They also assist the quality control team and medical director with appeals and rebuttals while identifying potential reimbursement savings.
The Setup Analyst is responsible for receiving, organizing, and accurately entering medical claims into the internal system while meeting production standards. They also support high-profile clients, train new employees, and ensure all duties are performed in compliance with HIPAA regulations.
The Clinical Review Supervisor manages daily activities for DRG Clinical Auditors and ensures the integrity of diagnosis and procedure code verification. They are responsible for maintaining quality standards, meeting quotas, and providing clinical support for medical record reviews.
The Itemization Review Nurse analyzes medical facility charges on UBIB forms to ensure billing accuracy. They are responsible for documenting conclusions, maintaining HIPAA compliance, and collaborating within a team environment.
The Certified Coder II is responsible for reverse coding medical bills to ensure accuracy and determining the validity and compensability of claims. They also communicate claim status to stakeholders and provide support for complex or problematic claims.
The Certified Coder II reverse codes medical bills to ensure coding accuracy and determines the validity and compensability of claims. They also communicate claim status to stakeholders and provide support for complex or problematic claims.
The Team Lead provides support to the Itemization Review Supervisor and coordinates with internal departments to ensure processing consistency. They are responsible for analyzing billing data, documenting conclusions, and maintaining quality assurance standards for the team.
The Certified Coder reverses codes previously coded medical bills to verify coding accuracy and is responsible for making claim-related recommendations and communicating the status of the claim to involved parties. This role involves processing claims based on state rules, determining claim validity using proprietary programs, and adhering to client and carrier guidelines.
The supervisor manages the daily activities of the payment integrity team, focusing on quality assurance and provider appeals, ensuring timely and accurate processing of requests and audits. Responsibilities include assisting the team with complex questions, conducting reviews based on clinical knowledge and payer policy, and managing employee guidance, coaching, and performance appraisals.
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 involves reviewing and analyzing internal audits and appeals using clinical judgment to interpret and apply relevant policies.
The Clinical Auditor will conduct DRG validation reviews of medical records to determine the accuracy of billing and coding, verifying documentation to establish the correct DRG assignment. This involves accurately documenting findings and providing clinical, policy, or regulatory support for all determinations made during the review process.
The specialist analyzes and monitors claims audit data, performing follow-up activities to ensure accurate reimbursement for healthcare providers by identifying and resolving payment variances. Key duties involve analyzing and repricing claims to meet contractual agreements and establishing accurate pricing structures.
The Itemization Review Team Lead supports the Supervisor by working with the IBR team and internal departments, maintaining Q&A support, and collecting data to analyze billing accuracy. This role requires documenting conclusions in the designated computer program while meeting departmental standards.
The Clinical Auditor will conduct DRG validation reviews of medical records to determine the accuracy of billing and coding, verifying findings against clinical documentation. This role involves accurately documenting determinations and providing necessary clinical, policy, or regulatory support for those findings.
The Clinical Review Supervisor performs DRG validation reviews of medical records to determine clinically supported DRG/coding according to contract methodologies. This role also involves supervising the daily activities of DRG Clinical Auditors and ensuring the integrity of their quality of diagnosis and procedure code verification.
The Hospital Bill Audit Nurse conducts hospital bill charge audits by reviewing medical records to verify services provided and charges are appropriate based on documentation and guidelines, covering areas like inpatient, outpatient, NICU, and hospice. This role involves identifying overcharges, undercharges, and unbundled items per payor contract and industry standards, requiring independent scheduling and travel to provider locations.
The Itemization Review Nurse analyzes charges on a UBIB submitted by a medical facility to determine the accuracy of billed charges by collecting and reviewing supporting data. This role requires documenting work and final conclusions in a designated computer program while maintaining an understanding of surgical implants.
The IT Compliance Analyst coordinates assessments, audits, and certifications across various frameworks like HITRUST, SOC, HIPAA, and NIST to maintain the organization's compliance posture. This role involves managing evidence, monitoring controls, maintaining documentation, and collaborating with IT, Security, Privacy, and Legal teams.
The Appeals Team Lead assists various stakeholders by locating providers within the Medical Provider Network (MPN), verifying inclusion, and scheduling appointments for injured workers. This role involves managing inbound and outbound calls while documenting bill review errors to improve team performance trends.
The Account Executive is tasked with interacting with customers and prospects at an executive level to sell new services and ensure clear communication of expectations across all internal teams. Responsibilities include meeting or exceeding sales goals, actively prospecting, and documenting all sales activities in sf.com.
The Correspondence Team Lead monitors and tracks all processes for the Correspondence Team, including running queries, maintaining reports, and compiling supporting documents for correspondence. This role is also responsible for training new analysts and tracking errors to create coaching measures.
The Analyst verifies provider information and processes documentation requests, such as itemized bills and medical records, to audit claims. Responsibilities also include ensuring the accuracy of patient, provider, and client information for proper request delivery.
The coder reverse codes previously coded medical bills to verify coding accuracy and is responsible for making claim-related recommendations. This role involves processing claims based on state rules, determining validity, and communicating claim status to relevant stakeholders.
The Implementation Manager is responsible for product enhancement and development while managing the implementation process from prospect presentation through conclusion for new and existing clients. This role facilitates the transition of client programs to field operations and account management personnel for ongoing service.
The Provider Management Analyst is tasked with verifying provider information and auditing claims documentation such as itemized bills and medical records. Responsibilities also include ensuring the accuracy of patient, provider, and client information to facilitate proper request delivery.
The supervisor is responsible for managing the daily production flow of a designated department, which may involve human resources and customer service functions, while promoting a positive influence over Setup Analysts. Key duties include implementing new business development, directing daily employee operations, setting department goals, and ensuring adherence to company policies and HIPAA compliance.
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 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 Itemization Review Nurse analyzes charges on a UBIB submitted by a medical facility by collecting supporting data to determine the accuracy of billed charges. This role requires appropriate documentation of work and final conclusions in the designated computer program.
