Top 90 Document reviewer Jobs in North Carolina

Grievance & Appeals Analyst (Full-time Remote NC Based)
Alliance Health —Morrisville, NC
- $61,439 - $79,871 a year
- Weekends as needed
- Remote
- Writing skills
- Mid-level
- Analysis skills
- Disability insurance
- Health insurance
10d
KBI: US - MS&T Data Reviewer I
KBI Biopharma —Durham, NC
- Full-time
- Microsoft Outlook
- Bachelor of Science
- Basic math
Onsite Reviewer - North Carolina
Staffing Solutions Organization LLC —Greenville, NC
- $26.50 an hour
- Full-time
- Experience working with individuals with developmental disabilities
- Clean driving record
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
1d
Telework US Government Grants Management Specialist / Grants Support Specialist
Arcetyp LLC —Raleigh-Durham, NC
- Full-time
- Remote
- Microsoft Outlook
- Mid-level
- Master's degree
Quick Apply
Police Investigation Tech - False Alarm Reduction Unit
City of Charlotte —Charlotte, NC
- $25.00 - $30.34 an hour
- Online Application
- Background check
- Microsoft Excel
- Microsoft Outlook
8d
Sr. Specialist, Compliance QA
Indivior —Raleigh, NC
- $88,000 - $108,000 a year
- Full-time
- 5 years
- ERP systems
- Computer skills
- Profit sharing
- Employee stock purchase plan
Safety Scientist
FATHOM LIFE SCIENCES & TECHNOLOGY SERVICES —Wilmington, NC
- Full-time
- Mid-level
- Bachelor's degree
- 1 year
PLAN REVIEWER
JDS Consulting, PLLC —Charlotte, NC
- $60,000 - $70,000 a year
- Full-time
- Remote
- Microsoft Outlook
- Residential
- Organizational skills
- Paid holidays
- Health insurance
Quick Apply
Examination Editor II
American Board of Anesthesiology Inc —Raleigh, NC
- Weekends as needed
- Writing skills
- Mid-level
- Bachelor's degree
Quick Apply
Sr. Quality Associate I, QA, Final Container Release
Grifols —Clayton, NC
- Full-time
- 5 years
- Bachelor of Science
- Mid-level
Physical Health Registered Nurse (Remote)
Vaya Health —North Carolina
- $68,033.34 - $88,443.35 a year
- Weekends as needed
- Remote
- Nursing
- RN License
- Computer literacy
10d
Analytical Quality Assurance Specialist(Microbiology)
Glenmark Pharmaceuticals Inc. —Monroe, NC
- Full-time
- Bachelor of Science
- Mid-level
- Analysis skills
English Contract Attorney
Contact Government Services, LLC —Charlotte, NC
- $27 - $40 an hour
- Contract
- Remote
- English
- Mid-level
- 2 years
Quick Apply
AVP, Actuary – US Fin Sol Pricing
SCOR —Charlotte, NC
- $162,500 - $220,000 a year
- Hybrid work
- 7 years
- Office
- Finance
- AD&D insurance
- Paid holidays
Staff Design Associate | Geostructures
BUNNELL LAMMONS ENGINEERING —Fletcher, NC
- Full-time
- Travel
- US work authorization
- 2 years
- Paid holidays
- Disability insurance
Quick Apply
Staff Associate | Geostructures
BUNNELL LAMMONS ENGINEERING —Fletcher, NC
- Full-time
- Travel
- US work authorization
- 2 years
- Paid holidays
- Disability insurance
Quick Apply
10d
Staff Design Associate | Geostructures
BUNNELL LAMMONS ENGINEERING —Charlotte, NC
- Full-time
- Travel
- US work authorization
- 2 years
- Paid holidays
- Disability insurance
Quick Apply
Staff Associate | Geostructures
BUNNELL LAMMONS ENGINEERING —Greensboro, NC
- Full-time
- Travel
- US work authorization
- 2 years
- Paid holidays
- Disability insurance
Quick Apply
10d
Staff Associate | Geostructures
BUNNELL LAMMONS ENGINEERING —Raleigh, NC
- Full-time
- Travel
- US work authorization
- 2 years
- Paid holidays
- Disability insurance
Quick Apply
10d
Staff Associate | Geostructures
BUNNELL LAMMONS ENGINEERING —Charlotte, NC
- Full-time
- Travel
- US work authorization
- 2 years
- Paid holidays
- Disability insurance
Quick Apply
10d

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document reviewer jobs near north carolina

Grievance & Appeals Analyst (Full-time Remote NC Based)

Alliance Health -
Morrisville, NC

Apply Now

Job Details

Full-time
$61,439 - $79,871 a year
10 days ago

Benefits

Disability insurance
Health insurance
Dental insurance
Paid time off
Vision insurance
Flexible schedule
Retirement plan

Qualifications

Customer communication
Writing skills
Bachelor's degree
Presentation preparation
Clinical data analysis

Full Job Description

The Grievance and Appeals Analyst responds to grievances and appeals to ensure the resolutions are consistent with organizational policies and procedures and which are compliant with state and federal guidelines and also ensures due process rights. The Analyst synthesizes and analyzes all available data which may contain multiple issues and may require coordination of responses from multiple business units. The Analyst ensures timely, customer focused responses to complaints and appeals, identifies trends and emerging issues, reports and recommends solutions. Works with internal and external customers to gather and verify information related to consumer safety and provider compliance. Identifies critical issues and triages issues appropriately to ensure that urgent member needs are met expediently. Communicates trends and actionable analysis to appropriate parties in a timely manner.

This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to the home office (Morrisville, NC) for onsite team meetings as needed.

Must have the flexibility to work weekends and holidays to fit the business needs.

Responsibilities & Duties

Management of General Functions

Responsible for receiving and monitoring information related to provider quality assurance issues including but not limited to grievances, quality of care concerns, and/or appeals
Works to ensure comprehensive quality assurance information is available to agency staff/departments as needed
Leverages critical thinking to identify trends within grievance, appeal, and other clinical data sources
Creates actionable analysis and identifies the most effective party to address any identified issues with minimal supervision
Works independently to mediate complex relationships between multiple external and internal stakeholder so that all parties are satisfied with identified resolutions
Ensures resolutions of issues related to member experiences are compliant with local, state and federal regulations
Utilizes various internal and external data platforms to perform a thorough analysis of issues related to member experiences
Utilizes professional communication skills to provide information to internal and external stakeholders verbally and in writing

Management of Grievances

Monitors timelines to ensure that quality assurance issues and reports are reviewed in a timely manner as to be most effective for agency processes
Uses analytical skills to define recommendations and improve practices
Creates and presents analyses of short-term studies using clear and direct language to explain trends and areas of opportunity to management and other staff; Trains internal and external customers on quality assurance reporting requirements
Reviews policies and procedures and makes recommendations for changes/edits in alignment with current guidelines and requirements
Collaborates with internal staff to ensure all relevant information is available for consideration

Management of Appeals

Prepares and ensures timely mailing of receipt of appeal and outcome notification letter to the individuals/ guardians and providers based on the most current formats and timeline requirements
Tracked appeal requests and assignment of the local reconsideration review process through resolution
Maintains all denial and appeals files in a an accessible manner
Participates in the development of internal training on Denial and Appeals as determined by the internal and external quality reviews
Aids legal counsel in ensuring fluent communication and exchange of documents are effectively made between all parties involved in the appeals process
Ensures Alliance staff are prepared for mediation and hearings by preparing and organizing all legal and clinical documents for 2nd level appeals
Assists in the discovery process with Alliance’s legal department and draft Office of Administrative Hearings (OAH) documents
Schedules mediation hearings and documents the process and outcomes
Provide training and technical assistance to staff regarding Due Process rules
Reviews first level appeal decisions to ensure first level appeal reviewers are applying service definition and clinical guidelines when making appeal determinations
Writes, edits, and/or coordinates the preparation of correspondence, reports, or other printed material according to well established standards or readily available
Performs other related duties as assigned

Minimum Requirements

Education & Experience

A minimum of a Bachelor’s degree from accredited college or university with a major in mental health, public health, psychology, sociology, public administration, management information systems, statistics, or a related field. A minimum of two years working human services/behavioral health post bachelor’s degree and/or a minimum of two years of experience analyzing data sets, interpreting and synthesizing data into a report format, and working with teams/units to integrate data information needs.

Knowledge, Skills, & Abilities

Knowledge of Federal and State regulations on Behavioral Healthcare grievances and appeals processes
Knowledge on medical records practices and records keeping practices
Knowledge of legal proceedings including mediation, administrative law courts, and other legal processes
Demonstrated proficiency in personal computer use and MS Excel
Some familiarity with other software packages, such as SPSS and MS Word, Project, Publisher, PowerPoint, and BI is desired
Must have good oral, written, and graphic presentation skills
Must demonstrate understanding of data analysis and techniques
Demonstrated ability to learn new software and user capabilities
Ability to integrate programmatic information into required data sets for analysis and interpretation
Ability to work well with others in a fast-paced, and sometimes stressful, environment
Experience with customer service, provider relations or similar activities is preferred
Experience working with individuals with mental health, substance abuse issues, and/or intellectual disabilities preferred

Employment for this position is contingent upon a satisfactory background and credit check, which will be performed after acceptance of an offer of employment and prior to the employee's start date.

Salary Range

$61,439-$79,871/Annually

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.

An excellent fringe benefit package accompanies the salary, which includes:

Medical, Dental, Vision, Life, Long Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options
Paid time off including vacation, sick leave, holiday, management leave
Dress flexibility

Education

Required

Bachelors or better in Human Services

Preferred

Bachelors or better in Psychology
Bachelors or better in Sociology

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

Apply Now

Refine Your Search

document reviewer jobs in north carolina

Grievance & Appeals Analyst (Full-time Remote NC Based)

KBI: US - MS&T Data Reviewer I

Onsite Reviewer - North Carolina

Telework US Government Grants Management Specialist / Grants Support Specialist

Police Investigation Tech - False Alarm Reduction Unit

Sr. Specialist, Compliance QA

Safety Scientist

PLAN REVIEWER

Examination Editor II

Sr. Quality Associate I, QA, Final Container Release

Physical Health Registered Nurse (Remote)

Analytical Quality Assurance Specialist(Microbiology)

English Contract Attorney

AVP, Actuary – US Fin Sol Pricing

Staff Design Associate | Geostructures

Staff Associate | Geostructures

Staff Design Associate | Geostructures

Staff Associate | Geostructures

Staff Associate | Geostructures

Staff Associate | Geostructures

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