Top 56 Communitycare Jobs

Medical Management - Medical Review Examiner Nurse 135-1009
CommunityCare —Remote
- Full-time
- Remote
- Background check
- Nursing
- RN License
Quick Apply
5d
Medical Management - Utilization Management RN 145-2011
CommunityCare —Remote
- Full-time
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- Background check
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- RN License
Quick Apply
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Patient Services Representative Specialist
CommUnityCare Health Centers —Austin, TX
- Full-time
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Accounting - Accounts Payable Clerk 125-1012
CommunityCare —Tulsa, OK
- Full-time
- Background check
- Office
- High school diploma or GED
Quick Apply
Medical Administrative Clerk (MAC)
CommUnityCare Health Centers —Austin, TX
- 8 hour shift
- Microsoft Outlook
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Configuration - Configuration Monitoring Specialist 200-1012
CommunityCare —Tulsa, OK
- Full-time
- Background check
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Claims HMO - Complex Claims Specialist 140-1039
CommunityCare —Tulsa, OK
- Full-time
- Background check
- Basic math
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Business Intelligence - Data Engineer 133-2015
CommunityCare —Tulsa, OK
- Full-time
- Background check
- Mid-level
- Organizational skills
Quick Apply
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Risk Adjustment - Risk Adjustment Coding Analyst 135-2014
CommunityCare —Tulsa, OK
- Full-time
- Background check
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- Mid-level
Quick Apply
Medical Assistant
CommUnityCare Health Centers —Del Valle, TX
- Full-time
- CPR Certification
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Medical Assistant Care Coordinator for Value Based Programs
CommUnityCare Health Centers —Austin, TX
- Full-time
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Care Model Front End Instructor
CommUnityCare Health Centers —Austin, TX
- Full-time
- Classroom
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Behavioral Health Program Manager
CommUnityCare Health Centers —Austin, TX
- Full-time
- Mid-level
- Administrative experience
- Bachelor's degree
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Quality Improvement - STARS Medication Adherence Specialist 195-1023
CommunityCare —Tulsa, OK
- Full-time
- Background check
- Research
- Mid-level
Quick Apply
7d
Electrician
CommUnityCare Health Centers —Austin, TX
- Full-time
- Mid-level
- 3 years
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Accounts Payable/Contract Coordinator
CommUnityCare Health Centers —Austin, TX
- Full-time
- Computer literacy
- Mid-level
- High school diploma or GED
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Ambulatory Operations Manager
CommUnityCare Health Centers —Austin, TX
- Full-time
- Mid-level
- High school diploma or GED
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8d
Operations Coordinator
CommUnityCare Health Centers —Austin, TX
- Full-time
- Mid-level
- High school diploma or GED
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1d
Pharmacy Technician
CommUnityCare Health Centers —Austin, TX
- Full-time
- CPR Certification
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Clinical Dietitian
CommUnityCare Health Centers —Austin, TX
- Full-time
- Spanish
- CPR Certification
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Medical Management - Medical Review Examiner Nurse 135-1009

CommunityCare
Remote

Quick Apply

Job Details

Full-time
5 days ago

Qualifications

Associate's degree

Full Job Description

JOB SUMMARY:
The Medical Review Examiner Nurse is responsible for auditing provider and facility claims. Identifying issues related to and/or participates in various projects aimed at identifying areas of non-compliance and/or potential fraud, waste and abuse, as it relates to provider billing practices.

KEY RESPONSIBILITIES:

Review claims by requesting medical records and other documents to evaluate for clinical appropriateness, coding compliance and validity of charges. Document ineligible charges and provide communications internally for claims processing and externally to providers.
Provide review of complex claims for further research meeting the MRE “pend” criteria. Collaborate with Medical Director and/or other departments (and resources) to make claim determinations.
Maintain tracking database including self-audit for quality control. Compile and analyze data and prepare routine reports as assigned. Identify trends and formulate recommendations based on findings. Suggest opportunities for special study.
Serve as an internal resource to provider services, contracting, claims, medical management, configuration, and appeals & grievances. Provide guidance as it relates to clinical appropriateness of services. Participate in provider education upon request.
Maintain files of MRE records. Participate in special projects and audits as assigned.

QUALIFICATIONS:

Extensive knowledge of ICD-9, ICD-10, HCPS, CPT-4 codes.
Able to work independently and meet stringent deadlines.
Successful completion of Health Care Sanctions background check.
Proficiency in claims processing software and Microsoft applications.
Possess strong oral and written communication skills.

EDUCATION/EXPERIENCE:

Current, active, unrestrictive license to practice as Registered Nurse (RN) or Licensed Practical Nurse (LPN) in the State of Oklahoma. Associates Degree required; Bachelor’s Degree preferred.
Five years of work experience in hospital, clinic or health plan clinical operations (for example utilization review, quality improvement, clinical claims review).
Experience or familiarity with state and federal regulations governing healthcare preferred.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

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Refine Your Search

Communitycare jobs

Medical Management - Medical Review Examiner Nurse 135-1009

Medical Management - Utilization Management RN 145-2011

Patient Services Representative Specialist

Accounting - Accounts Payable Clerk 125-1012

Medical Administrative Clerk (MAC)

Configuration - Configuration Monitoring Specialist 200-1012

Claims HMO - Complex Claims Specialist 140-1039

Business Intelligence - Data Engineer 133-2015

Risk Adjustment - Risk Adjustment Coding Analyst 135-2014

Medical Assistant

Medical Assistant Care Coordinator for Value Based Programs

Care Model Front End Instructor

Behavioral Health Program Manager

Quality Improvement - STARS Medication Adherence Specialist 195-1023

Electrician

Accounts Payable/Contract Coordinator

Ambulatory Operations Manager

Operations Coordinator

Pharmacy Technician

Clinical Dietitian

I want to receive the latest job alert for Communitycare

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