Perform medical claim reviews to determine medical necessity and appropriateness based on established clinical guidelines and protocols. Document medical rationales for payment or denial and provide guidance to LPN team members and non-medical staff.
Palmetto GBA
8 Remote Job Openings at Palmetto GBA
Conducts comprehensive financial, compliance, and operational audits to evaluate internal controls and identify business risks. Prepares detailed audit reports and recommendations for executive management to improve processes and prevent fraud.
Conducts a full range of Medicare financial compliance, operational, and internal control audits to identify business risks. Drafts detailed audit reports and recommendations for executive management to improve processes and prevent fraud.
Acts as a Team Lead for specialty programs, providing guidance, training, and support to staff in medical review and utilization management. Monitors workflow, addresses aging issues, and ensures the quality of healthcare services provided under the ESRD QIP Contract.
Conducts comprehensive financial, compliance, and operational audits to evaluate internal controls and identify business risks. Prepares detailed audit reports and recommendations for executive management to improve corporate processes and prevent fraud.
Conduct internal and external financial, compliance, and operational audits to evaluate internal controls and identify business risks. Draft detailed audit reports and recommendations for executive management to improve processes and prevent fraud.
Physical Medicine and Rehabilitation Medical Director
Palmetto GBA
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Full Time
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11 days ago
Palmetto GBA
Provides administrative oversight to medical staff and analyzes medical review utilization data to inform policies. Acts as a resource for providers and researches new medical procedures and technology to develop claim adjudication criteria.
Conducts a full range of financial, compliance, and operational audits to evaluate internal controls and identify business risks. Drafts detailed audit reports and recommendations for executive management to improve corporate processes and prevent fraud.
