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Care Review Clinician, Prior Authorization Nurse
Molina Healthcare
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Columbus, OH
... Refers appropriate prior authorization requests to Medical Directors. Requests additional information from members or ... Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. ... - May 05
WC Medical Claims Specialist -PN
ohio.gov
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Franklin County, OH
... Issue initial orders to Accept, Deny, or Dismiss, Medical Only Claims in addition to Subsequent Determinations through a thorough investigation of all medical and legal evidence available in the claim. Review complex claim issues with team members, ... - Apr 28
Clinical Review Clinician - Appeals
Pyramid Consulting, Inc
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Clinton Township, OH, 43224
... ensure a complete case summary is provided to the Medical Director for review of the appeal case. Review medical code data and records to determine whether a denial is warranted. Utilizing multiple appeals/claims systems to conduct medical reviews. ... - May 05
Claims Adjuster
Central Ohio Transit Authority
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Columbus, OH, 43215
... Works with COTA's outside adjuster regarding claims and lawsuits; Works with COTA's external experts to assist in preservation of evidence requests. Review collections files in a timely manner and, if applicable, prepare them for Senior Associate ... - May 04
Workers' Compensation Claims Assistant - PN
ohio.gov
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Franklin County, OH
... into Claims Management System · Contacts appropriate individuals to obtain missing information. · Reviews incoming claims documents (e.g. motions, appeals, self-insured applications, C9s, C92/C92As) to determine required action; requests medical ... - Apr 28
WC Medical Claims Specialist -PN
Workers' Compensation
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Columbus, OH, 43215
... Issue initial orders to Accept, Deny, or Dismiss, Medical Only Claims in addition to Subsequent Determinations through a thorough investigation of all medical and legal evidence available in the claim. Review complex claim issues with team members, ... - Apr 30
Clinical Review Clinician - Appeals
Pyramid Consulting
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Clinton Township, OH, 43224
... ensure a complete case summary is provided to the Medical Director for review of the appeal case. Review medical code data and records to determine whether a denial is warranted. Utilizing multiple appeals/claims systems to conduct medical reviews. ... - Apr 24
Claims Adjuster
Central Ohio Transit Authority
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Columbus, OH
... Works with COTA's outside adjuster regarding claims and lawsuits; Works with COTA's external experts to assist in preservation of evidence requests. Review collections files in a timely manner and, if applicable, prepare them for Senior Associate ... - Apr 25
Clinical Review Clinician - Appeals
Spectraforce Technologies
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Clinton Township, OH, 43224
... Clinical Review Clinician - Appeals Location: Remote (Columbus area, OH Preferred) Duration: 6 Months (Potential to Extend) ?8a-5p (NO OT req) Position Purpose: Performs clinical reviews needed to resolve and process appeals by reviewing medical ... - May 05
Dental Claims Specialist
Ohio State University
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Columbus, OH, 43201
... If you have questions while submitting an application, please review these frequently asked questions. Current Employees and ... enters dental and medical coding; ability to bill medical/dental carriers, appeal claims, and collection functions; serves ... - Apr 17