Top 48 Laboratory data reviewer Jobs in Remote

Claims Auditor, Reviewer and Coder
Planned Systems International, Inc. —Remote
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- 5 years
- AD&D insurance
- Disability insurance
21h
Utilization Review Specialist
We Level Up —Pompano Beach, FL
- $50,000 - $90,000 a year
- Full-time
- Remote
- 18 years or older
- CPR Certification
- HIPAA
Quick Apply
Associate Research Director - Complex Care
Private Health Management —Remote
- $110,000 - $125,000 a year
- Remote
- Analysis skills
- Doctor of Philosophy
- US work authorization
- Health insurance
- Dental insurance
Quick Apply
Genetic Counselor Clinical Reviewer - EviCore - Remote
The Cigna Group —Remote
- $73,200 - $122,000 a year
- Online Application
- Remote
- Customer service
- Mid-level
- Master's degree
- Paid holidays
- Health insurance
Lead Clinical Research Associate
PSI CRO —Remote
- Full-time
- Remote
- Medicine
- English
- Driver's License
Quick Apply
CardioMed Device Consultants- Principal Consultant
BDC Laboratories —Edgewater, MD
- Full-time
- Remote
- Public speaking
- Mentoring
- Senior level
Quick Apply
Environmental Consulting Client Manager
Foth —Green Bay, WI
- $150,000 - $180,000 a year
- Full-time
- Remote
- 5 years
- Engineering
- Continuous improvement
- Paid holidays
- Health insurance
Quick Apply
Project Director
Foth —Dallas, TX
- $155,000 - $200,000 a year
- Full-time
- Remote
- Engineering
- 11+ years
- Analysis skills
- Paid holidays
- Health insurance
Quick Apply
Environmental Client Manager
Foth —Green Bay, WI
- Full-time
- Remote
- 5 years
- Engineering
- Continuous improvement
- Work from home
Quick Apply
Aerospace Engineer
Arcfield —Colorado Springs, CO
- $83,623.66 - $145,405.33 a year
- Full-time
- Remote
- Bachelor of Science
- Analysis skills
- C++
- Paid holidays
- Disability insurance
10d
Client Manager - Marine Infrastructure
Foth —Marion, MA
- $130,000 - $170,000 a year
- Full-time
- Remote
- Engineering
- Continuous improvement
- Travel
- Paid holidays
- Health insurance
Quick Apply
Business Development Manager - Automation
Foth —Minneapolis, MN
- $140,000 - $170,000 a year
- Full-time
- Remote
- Up to 50% travel
- PMP
- Travel
- Paid holidays
- Health insurance
Quick Apply
Field Evaluations Engineer - Dallas Fort Worth
UL Solutions —Dallas, TX
- $97,000 - $120,000 a year
- Holidays
- Remote
- 8 years
- Travel
- Senior level
- Health insurance
- Dental insurance
Field Evaluations Engineer - North Carolina Area
UL Solutions —Raleigh, NC
- $100,000 - $115,000 a year
- Holidays
- Remote
- 8 years
- Travel
- Senior level
- Health insurance
- Dental insurance
Field Evaluations Engineer - Northern California
UL Solutions —Fremont, CA
- $97,000 - $120,000 a year
- Holidays
- Remote
- Computer literacy
- 8 years
- Travel
- Health insurance
- Dental insurance
12d
Lead Water Resources Engineer
Foth —Louisville, KY
- $130,000 - $160,000 a year
- Full-time
- Remote
- 11+ years
- Bachelor's degree
- Team management
- Paid holidays
- Health insurance
Quick Apply
Field Evaluations Engineer - San Diego
UL Solutions —San Diego, CA
- $97,000 - $120,000 a year
- Holidays
- Remote
- Computer literacy
- 8 years
- Travel
- Health insurance
- Dental insurance
Project Civil Engineer - Marine Infrastructure
Foth —Nashville, TN
- Full-time
- Remote
- 7 years
- Management
- Bachelor's degree
Quick Apply
Lead Civil Engineer - Marine Infrastructure
Foth —Memphis, TN
- Full-time
- Remote
- 5 years
- Bachelor's degree
- Mentoring
Quick Apply
Lead Waterfront/Marine Structural Engineer
Foth —Milwaukee, WI
- $110,000 - $165,000 a year
- Full-time
- Remote
- Engineering
- Mentoring
- Military encouraged
- Paid holidays
- Health insurance
Quick Apply

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laboratory data reviewer jobs near remote

Claims Auditor, Reviewer and Coder

Planned Systems International, Inc. -
Remote

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Job Details

Full-time
21 hours ago

Benefits

AD&D insurance
Disability insurance
Health insurance
Dental insurance
Flexible spending account
Tuition reimbursement
Vision insurance
401(k) matching
Life insurance

Qualifications

Microsoft Excel
Microsoft Outlook
Health data analysis
Managed care
Managed care organization experience
Research
Overseeing health insurance pre-authorization
Communication platforms
Quality control audit
Collaborative technology platforms
Microsoft Teams
SharePoint
Health information management
Quality audits
Insurance claims auditing
DRG

Full Job Description

Overview:

Advanced Technologies & Laboratories International, Inc. (ATL) is hiring a Claims Auditor, Reviewer and Coder. The Contractor shall provide expertise in quality assurance, claims processing, medical coding, and audit activities for the WTC Health Program. Responsibilities include supporting quality assurance and audit planning, conducting claims reviews and audits, analyzing claims data to identify trends and issues, researching federal payer coverage policies, developing and improving program policies and procedures, maintaining the health plan codebook, ensuring accurate application of medical coding standards, and recommending improvements to processes and benefit plans based on industry best practices, coding guidance, reimbursement policies, and evidence-based healthcare standards.

On July 1, 2011, Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), WTC Health Program was established as a federal health care program to provide medical monitoring and treatment for eligible members in accordance with the James Zadroga 9/11 Health and Compensation Act of 2010. On December 18, 2015, President Obama signed the James Zadroga 9/11 Health and Compensation Reauthorization Act which reauthorized the WTC Health Program for 75 years, ending in 2090.

Essential Functions and Job Responsibilities:

The Contractor shall support the development and implementation of the WTC Health Program’s Quality Assurance Plan, including the development and implementation of the WTC Health Program’s Audit Plan
The Contractor shall use the WTC Health Program administrative manual, medical benefit plan resources, and other applicable Program guidance to support claims review, audit activities, prior authorization recommendations, and policy interpretation.
The Contractor shall serve as an expert to the Program on claims processing and formal reviews (audits); supports Program claims reviews (audits) consistent with claims audits in the health insurance industry and the policies and procedures of the WTC Health Program.
The Contractor shall conduct research and reviews of federal payor coverage determinations, administrative/clinical activities, for development of policies and procedures, completeness, and alignment with Program requirements.
The contractor shall analyze raw claims data to independently identify issues, patterns, and trends, and make final recommendations to the WTC Health Program on appropriateness for services within treatment/benefit plans, using health insurance reimbursement, medical coding/claims knowledge and expertise.
The contractor shall support management and maintenance of the Program’s health plan codebook, make recommendations for code additions, and review claims to ensure proper application of ICD, HCPCS, CPT, and DRG codes.
The contractor shall remain up to date with coding conventions, evidence-based practices, and federal payer policies.
The Contractor shall continuously review and participate in industry changes and updates, specifically but not limited to, ICD-10-CM/OCS ad AMA CPT coding guidelines to look for, and develop ways, to evaluate, improve research strategy, processes, policies, and procedures within the WTC Health Program in accordance with the Research and Evaluation Branch’s and Quality and Evaluation Team’s functions and goals.
The Contractor shall interface and collaborate with clinicians, medical administrators, federal staff, contract staff, and occupational health subject matter experts to support medical management, claims review, audit activities, and prior authorization recommendations.
The Contractor shall connect claims quality findings to broader quality assurance, utilization review, and program evaluation objectives, including identifying issues that may affect Program operations, reporting, or policy implementation.

Minimum Requirements:

A bachelor’s or master’s degree in a health profession (HIM, MPH, MHA, RN, PA, other health profession) preferred
A minimum of 5 years’ experience working with health insurance payor claims data in a health plan or managed care setting, with experience in healthcare quality, medical coding, and claims auditing.
Demonstrated expertise is in CPT, HCPC and ICD billing codes, authorization requirements and documentation, DRG, and health care claims data analysis
Registered health information administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) certification desirable
Proficient in Microsoft Office Suites, including Excel, Outlook, and SharePoint

Required Technical/Business Tools Experience

MS Office (Word, Excel, Powerpoint, Outlook)
Communication tools (Teams, SharePoint)

Company Benefits:

PSI offers full-time, benefits eligible employees a competitive total compensation package that includes paid leave, and options for employer sponsored group medical, dental, vision, short-term and long-term disability, life insurance, AD&D coverage, legal services, identity theft, and accident insurance. Flexible spending account and health saving account options offer pre-tax savings for qualified medical, dental, and vision expenses. The company sponsored 401(k) retirement plan has an employer contribution match that is immediately vested. We invest in the professional growth of our employees through professional courses, certifications, and tuition reimbursement programs.

EEO Commitment:

It is company policy to promote equal employment opportunities. All personnel decisions, including, but not limited to, recruiting, hiring, training, promotion, compensation, benefits, and termination, are made without regard to race, color, religion, age, sex, sexual orientation, pregnancy, gender identity, genetic information, national origin, citizenship status, veteran status, protected veteran status, disability, or any other characteristic protected by applicable federal, state, or local law.

Reasonable accommodations for applicants and employees with disabilities will be provided. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Human Resources by emailing [email protected], or by dialing 703-575-8400.

Apply Now

Refine Your Search

laboratory data reviewer jobs in remote

Claims Auditor, Reviewer and Coder

Utilization Review Specialist

Associate Research Director - Complex Care

Genetic Counselor Clinical Reviewer - EviCore - Remote

Lead Clinical Research Associate

CardioMed Device Consultants- Principal Consultant

Environmental Consulting Client Manager

Project Director

Environmental Client Manager

Aerospace Engineer

Client Manager - Marine Infrastructure

Business Development Manager - Automation

Field Evaluations Engineer - Dallas Fort Worth

Field Evaluations Engineer - North Carolina Area

Field Evaluations Engineer - Northern California

Lead Water Resources Engineer

Field Evaluations Engineer - San Diego

Project Civil Engineer - Marine Infrastructure

Lead Civil Engineer - Marine Infrastructure

Lead Waterfront/Marine Structural Engineer

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