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The physician reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care.
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As Physician Reviewer/Advisor for Disability Peer Review, you will utilize clinical expertise to review medical records provided and return an independent, professional opinion on the clamants functionality and restrictions or limitations as it relates to an application for disability benefits or the current status of disability.
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Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision-making and rationales in reviews; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes.
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Premium Audit ReviewerAmerican National is hiring a Premium Audit Reviewer to join our team. Handle Premium Audit disputes by applying state regulations and audit rules to each case. Premium Audit ReviewerAmerican National is hiring a Premium Audit Reviewer to join our team.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Our reviewers are compensated on a per-case basis as a 1099 independent contractor. Reviews all medical records and addresses each question posed by the client utilizing client specific criteria or other nationally recognized evidence-based criteria.
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Experience with Community Based Mental Health Services (e.g. Case Management, TDT, IIH, MHSS, IOP) Acentra seeks a Behavioral Health UM Clinical Reviewer (PRN, Remote within Virginia) with an active RN, LCSW, LPC, and/or LBA to join our growing team.
TemporaryRemoteExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Experience conducting employment tax examinations (e.g., non-filers, 1120S officer compensation, worker classification, tip audits with multiple establishments, accountable plans, mergers & acquisitions, advanced executive compensation, advanced fringe benefits, and large case audits.
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Vacancies will be filled in the following specialty areas: Whistleblower Office Case Development CDO, Award Recommendation and Coordination (ARC) and Litigation Monitoring Notification (LMN). Evaluates evidence and information used to support the examiner's conclusions to determine if documentation and case development are adequate.
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Train QC Case Reviewer on these rules and procedures on an on-going basis to keep current with departmental procedures and Federal, State and City revisions. Provide guidance and clarification to QC Case Reviewers on Federal/State rules and regulations to ensure adherence to the SNAP Source Book.
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Follows applicable procedures for case assembly, return and processing. Experience analyzing and presenting detailed case and issue information using written communication skills to provide feedback to program managers, analysts and field personnel.
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Ensure cases are returned by the reviewer in a timely manner in order to meet case deadlines. We process over 200,000 insurance claims annually for leading national and regional Workers Compensation, Disability, Auto and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers and Pharmacy Benefit Managers.
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BASIC REQUIREMENT: A Certificate as a Certified Public Accountant (CPA) or a bachelor's or higher degree in accounting that included at least 30 semester hours in accounting or 24 semester hours in accounting and an additional 6 semester hours in related subjects such as business law, economics, statistical/quantitative methods, computerized accounting or financial systems, financial management, or finance.
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The Utilization Management (UM) Reviewer, in collaboration with other internal and external offices, payors, and providers and staff, is responsible for the coordinates Utilization Management (UM) processes and requirements for prior authorization/certification for reimbursement of patient care services.
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Visit the IRS SPD Library to access the position descriptions. Experience working employment tax issues such as Section 530, backup withholding, expense reimbursements and excess allowances, cafeteria plans, resident and non-resident alien issues, common paymaster and successor employer, stock options and stock purchases, nonqualified deferred compensation plans, severance pay/golden parachutes, tool and equipment rental, identifying, referring and working fraud cases, and information return and trust fund penalties.
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TIME AFTER COMPETITIVE APPOINTMENT: By the closing date (or if this is an open continuous announcement, by the cut-off date) specified in this job announcement, current civilian employees must have completed at least 90 days of federal civilian service since their latest non-temporary appointment from a competitive referral certificate, known as time after competitive appointment.
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