Top 39 Utilization review Jobs in Milford Ct

Insurance Reimbursement Specialist
Aspira Labs, Inc. —Shelton, CT
- Full-time
- Microsoft Word
- Microsoft Excel
- HIPAA
Quick Apply
Utilization Review and Appeals Case Manager
Stony Brook University Hospital —Stony Brook, NY
- $89,760 - $127,975 a year
- Online Application
- Bilingual
- Nursing
- RN License
Regional MDS Coordinator
Ryders Health Management —Stratford, CT
- $46 - $50 an hour
- Temporary
- Anatomy knowledge
- RN License
- HIPAA
- Free parking
- Health insurance
Quick Apply
5d
Case Manager
Waterbury Hospital —Waterbury, CT
- Full-time
- Nursing
- RN License
- Hospital
Clinical Case Manager
Waterbury Hospital —Waterbury, CT
- Part-time
- Nursing
- RN License
- Hospital
Behavioral Health Clinical Coordinator LCSW, LPC, LMFT
Pyramid Healthcare —Norwalk, CT
- $68,000 - $70,000 a year
- Full-time
- LMFT
- Addiction Medicine
- Licensed Clinical Social Worker
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse Supervisor/3rd Shift
Lutheran Home of Southbury —Southbury, CT
- Overnight shift
- Nursing
- Skilled nursing facility
- RN License
- Free parking
- 403(b) matching
Quick Apply
Registered Nurse Float Nurse/3rd Shift
Lutheran Home of Southbury —Southbury, CT
- Overnight shift
- Nursing
- Skilled nursing facility
- Float pool
- Health insurance
- Dental insurance
Quick Apply
2d
Registered Nurse (RN) Supervisor/Baylor Nurse, 7am-3pm and 3-11pm - EO Weekend
Lutheran Home of Southbury —Southbury, CT
- 8 hour shift
- Nursing
- Skilled nursing facility
- Management
- Health insurance
- Dental insurance
Quick Apply
Psychiatric Nurse Practitioner
Southbury Counseling —Southbury, CT
- $80 - $120 an hour
- Part-time
- Hybrid work
- Experience working with individuals with developmental disabilities
- Nursing
- Psychiatry
- Health insurance
- Dental insurance
Quick Apply
Denials and Appeals Case Manager
Stony Brook University Hospital —East Setauket, NY
- $89,760 - $127,975 a year
- Online Application
- Acute care
- Bilingual
- Microsoft Word
- Health insurance
Case Manager
Stony Brook University Hospital —Stony Brook, NY
- $89,760 - $127,975 a year
- Online Application
- Bilingual
- Nursing
- RN License
- Health insurance
Case Manager- Part Time Temporary
Stony Brook University Hospital —Stony Brook, NY
- $88,000 - $125,466 a year
- Part-time
- Bilingual
- Nursing
- RN License
Behavioral Health Clinical Supervisor (40 Hour) (Office/On-site)
State of Connecticut - Department of Mental Health & Addiction Services —Bridgeport, CT
- $116,144 - $155,821 a year
- Urgently hiring
- Nursing
- Addiction Medicine
- RN License
8d
RN Case Manager
Stony Brook University Hospital —Stony Brook, NY
- $88,000 - $125,466 a year
- Online Application
- Bilingual
- Nursing
- RN License
- Health insurance
Pharmacist
Green Thumb —Branford, CT
- No experience needed
- Mid-level
- Driver's License
Quick Apply
5d
Director of New Prospects
RECOVERY NETWORK OF PROGRAMS, INC. —Bridgeport, CT
- On call
- LMFT
- Writing skills
- Licensed Clinical Social Worker
Quick Apply
Hub Manager - Care Coordination ( RN ) Per Diem
Catholic Health —Port Jefferson, NY
- $48.67 - $69.00 an hour
- Per diem
- Nursing
- RN License
- Hospital
Licensed Clinical Social Worker
Northwell Health —Danbury, CT
- $33.21 - $61.68 an hour
- Full-time
- Psychiatry
- Hospital
- 5 years
Quick Apply
7d
Case Manager Supervisor
Stony Brook University Hospital —Stony Brook, NY
- $107,100 - $152,698 a year
- Weekends as needed
- Bilingual
- Nursing
- RN License
- Health insurance

I want to receive the latest job alert for utilization review in milford ct

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Insurance Reimbursement Specialist

Aspira Labs, Inc.
Shelton, CT

Quick Apply

Job Details

Full-time

Qualifications

Microsoft Word
Customer communication
Microsoft Excel
Accounts receivable management
Word embeddings
HIPAA
Medicare regulations
Healthcare privacy protection
Health information regulatory compliance
Medicaid regulations
Medicaid

Full Job Description

Job Title: Insurance Reimbursement Specialist

Department: Billing

Reports To: Revenue Cycle Manager

Location: Shelton, CT

Terms: Full-time

FLSA Status: Exempt

POSITION SUMMARY

As an Insurance Reimbursement Specialist, you will work with insurance and billing companies to process medical reimbursements for patients. Your primary duties include claim review, appeal generation, interacting with patients, communicating with insurance providers, assist with retrieving EOBs, and other duties as assigned. To be successful in this role, you need strong analytical, communication, and organizational skills.

ESSENTIAL FUNCTIONS

Responsible for submission of appeals to national payers
Provide review of all levels of an insurance appeal
Gather supporting documentations (physician medical records, patient /physician letters etc.)
Work incoming correspondence from payors to assist with claim appeal
Interact with utilization review/management departments
Assist with gathering EOB’s if cash poster is unable to locate
Provide excellent customer service via the handling of inbound and outbound calls/emails to patients and providers
Data Entry
Assist with Error Processing when business volume dictates the need

PERFORMANCE MEASURES

Review claim denials within 1 week of posting to determine next step for accession
Submit request to provider for necessary documentation for appeal- follow up on requests within 2 weeks if not received.
Submit accessions for adjustments per Patient Transparency Program guidelines and document accession to reflect need for adjustment accurately
Follow up with plans when trends of nonpayment or incorrect payment is received per contracts
Utilize portals/fax/USPS to submit appeals for claim review when necessary. USPS should be last resort if portal/Fax unavailable
Provide payor status updates when issues arise to leadership
Review Sfax for documentation relating to payor groups daily
Review correspondence at the time of working denials to verify if we received essential information for the claim.
Provide response to patient and client emails/voicemails within 24 business hours of receipt and document account appropriately
Adherence to schedule
Productivity based on accuracy and quality
Maintain a positive, achievement-oriented attitude and influence others to do the same
Demonstrate high ethical standards and personal integrity
Display a commitment to personal growth

MINIMUM QUALIFICATIONS

College degree preferred or equivalent but will substitute for applicable work experience
Minimum two (2) years’ experience in healthcare accounts receivable environment; knowledge of medical terminology, billing, and coding a plus
Demonstrate proficiency in Microsoft Word and Excel
Adhere to Medicare, Medicaid Compliance and HIPAA guidelines in relation to PHI information

KNOWLEDGE, SKILLS, AND ABILITIES

Exceptional analytical and organizational skills
Ability to work independently, a team player with strong interpersonal skills to effectively interact with all levels of employees
Superior time management and critical thinking skills
Ability to work under pressure and achieve goals efficiently
Strong written and verbal communication skills
Dependable, flexible, and adaptable in all aspects of work

SUPERVISORY RESPONSIBILITES

No direct supervisory responsibilities

Quick Apply

Refine Your Search

utilization review jobs in milford ct

Insurance Reimbursement Specialist

Utilization Review and Appeals Case Manager

Regional MDS Coordinator

Case Manager

Clinical Case Manager

Behavioral Health Clinical Coordinator LCSW, LPC, LMFT

Registered Nurse Supervisor/3rd Shift

Registered Nurse Float Nurse/3rd Shift

Registered Nurse (RN) Supervisor/Baylor Nurse, 7am-3pm and 3-11pm - EO Weekend

Psychiatric Nurse Practitioner

Denials and Appeals Case Manager

Case Manager

Case Manager- Part Time Temporary

Behavioral Health Clinical Supervisor (40 Hour) (Office/On-site)

RN Case Manager

Pharmacist

Director of New Prospects

Hub Manager - Care Coordination ( RN ) Per Diem

Licensed Clinical Social Worker

Case Manager Supervisor

I want to receive the latest job alert for utilization review in milford ct

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