Medical Reviewer Salary in USA

Logo:Posting Number:STA00267PO24Job Family:Enrollment ManagementJob Function:AdmissionsUSC Market Title:Admissions RepresentativeLink to USC Market Title:https://uscjobs.sc.edu/titles/132599Job Level:P1 - ProfessionalBusiness Title (Internal Title):Application ReviewerCampus:ColumbiaWork County:RichlandCollege/Division:Enrollment ManagementDepartment:EM Undergraduate AdmissionsState Pay Band:5Approved Starting Salary:$41,258Advertised Salary Range:$41,258Part/Full Time:Full TimeHours per Week:37.5Work Schedule:Monday - Friday 8:30AM-5:00PM, One hour for lunch.Occasional overtime on nights/weekends may be required.Must be willing to work a flexible schedule to meet the needs of the department.Basis :12 monthsJob Search Category:Student ServicesAbout University of South Carolina:From the Upstate to the Lowcountry, the University of South Carolina system is transforming the lives of South Carolinians through the impact of our eight institutions and 20 locations throughout the state. More than 50,000 students are enrolled at one of eight institutions, including the research campus in Columbia and comprehensive four-year universities in Aiken, Upstate and Beaufort. In addition, our Palmetto College campuses in Salkehatchie, Union, Lancaster and Sumter enable students to earn associate or bachelor's degrees through a combination of in-person, online or blended learning. All of our system institutions place strong emphasis on service - helping to build healthier, more educated communities in South Carolina and beyond.Inclusive Excellence Statement:At the University of South Carolina, we strive to cultivate an inclusive environment that is open, welcoming, and supportive of individuals of all backgrounds. We recognize diversity in our workforce is essential to providing academic excellence and critical to our sustainability. The University is committed to eliminating barriers created by institutional discrimination through accountability and continuous process improvement. We celebrate the diverse voices, perspectives, and experiences of our employees.Advertised Job Summary:The Office of Undergraduate Admissions seeks an Application Reviewer. The application reviewer will process all types of applications for Undergraduate Admissions, including freshman, transfer, readmit, international, and non-degree. Processing includes data entry, grade point computations, and determination of compliance with admissions requirements. Will also research other college grading systems to determine admissions transferability of courses.The Application Reviewer is required to assist with other tasks within the Operations division, including but not limited to: requesting credentials, responding to telephone and email inquiries from prospective students, and indexing credentials.This person will serve as the primary admissions contact for special populations to prospective students and applicants, to include responding to emails and phone calls. Conduct outreach to ensure file completion and timely decision release. Assist applicants through the admissions and enrollment processes.Some seasonal overtime may be required.Minimum Qualifications:Bachelor's degree and 1 or more years of experience, which may be substituted by equivalent combination of certification, training, education, and/or experience.Preferred Qualifications:Admissions and/or higher education background helpful.Knowledge/Skills/Abilities:Strong typing skills. Ability to manage multiple priorities simultaneously and the ability to follow through independently on tasks. Good oral and written communications skills and the ability to work well with others.Job Duty:Process admission applications in the university's student information system and the Customer Relationship Management (CRM) system for freshmen, transfers, readmits, non-degrees, internationals, and special populations.Essential Function:YesPercentage of Time:30Job Duty:Review each applicant file and identify credentials needed to make an admissions decision. Request missing credentials from the applicant via email and phone call. Answer telephone calls regarding admission applications. Provide accurate information, research questions, and assist applicants with the admission process.Essential Function:YesPercentage of Time:20Job Duty:Review high school and college transcripts, determine grade point averages, and enter coursework and applicant information in the university's student information system and the Customer Relationship Management (CRM) system. Research high school and college transcripts for grading scale and weighting of courses.Essential Function:YesPercentage of Time:20Job Duty:Issue an admission decision by adhering to the guidelines and timetables set by the department, and assist with holistic review of applicant files as needed.Essential Function:YesPercentage of Time:15Job Duty:Assist with completing special projects including but not limited to correcting inaccurate or missing data on applicant records. Other duties as assigned.Essential Function:YesPercentage of Time:5Job Duty:Serve as a primary admissions contact for special populations at the inquiry and application levels, to include responding to emails and phone calls; researching applicant questions which may include contacting campus partners on behalf of the student; provide excellent customer service. Conduct outreach to ensure file completion and timely decision release. Assist applicants through the admissions and enrollment processes to help ensure a seamless enrollment process, consulting with campus partners as needed.Essential Function:YesPercentage of Time:10Safety Sensitive or Security Sensitive:NoHazardous weather category:Non-EssentialNumber of Vacancies:1Desired Start Date:05/28/2024Job Open Date:03/27/2024Job Close Date:04/26/2024Open Until Filled:NoSpecial Instructions to Applicant:Positions are advertised for a minimum of five (5) business days on our job website. After five (5) business days, positions can be closed at the discretion of the department at any time. This employment site is updated on a regular basis. The length of the recruitment and screening process may vary from position to position, depending upon a variety of factors. Should review of your qualifications result in a decision to pursue your candidacy, you will be contacted by phone or email. We are only accepting applications submitted by April 26, 2024.The University of South Carolina offers a valuable benefits package including but not limited to:Health and Life InsuranceRetirement ProgramsPaid TuitionDependent ScholarshipsAnnual LeaveSick Leave13 Paid Holidays (including an extended December holiday)Paid Parental LeaveProfessional Development Opportunities Click here to learn more about why you should work at USC.Quicklink for Posting:https://uscjobs.sc.edu/postings/166183EEO Statement:The University of South Carolina does not discriminate in educational or employment opportunities or decisions for qualified persons on the basis of age, ancestry, citizenship status, color, disability, ethnicity, familial status, gender (including transgender), gender identity or expression, genetic information, HIV/AIDs status, military status, national origin, pregnancy (false pregnancy, termination of pregnancy, childbirth, recovery therefrom or related medical conditions, breastfeeding), race, religion (including religious dress and grooming practices), sex, sexual orientation, veteran status, or any other bases under federal, state, local law, or regulations.

Location: Springfield, ILDescription: Our client is currently seeking a Physician Reviewer Responsible for ensuring the company meets their product standards and commitments to customers and for ensuring physician utilization of company protocols, guidelines and policies/procedures. Primary duties may include, but are not limited to: Maintains the quality and timeliness of peer clinical and/or appeal case review decision making across all product lines, consults with team members to ensure consistency, and superior customer service, improves service to clients and unit productivity through continuous enhancement of whole team clinical knowledge and enhanced understanding of company systems, products, programs, procedures and customers. Interprets existing policies and develops new policies based on changes in the healthcare or medical arena and supports the Medical Management staff ensuring timely and consistent responses to members and providers. Identifies and develops opportunities for innovation to increase effectiveness and quality. Serves as a resource and consultant to other areas of the company, may be required to represent the company to external entities and/or serve on external committees, conduct peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations and provides guidance for clinical operational aspects of the program. Requires M.D. or D.O.; Board certification approved by the American Board of Medical Specialties required, Must possess an active unrestricted medical license to practice medicine or a health profession. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US, and 5 years clinical experience ; or any combination of education and experience, which would provide an equivalent background.Manager Notes:Previous utilization management experience as a physician reviewerQualifications -o Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine.o Board Certified in Internal Medicine or an Internal Medicine Subspecialty, Pediatrics, Family Medicine or Physical Medicine and Rehabilitationo Strong oral communication and interpersonal skills.o Computer literacy with the ability to learn new applications.o Ability to multi-task.o Ability to work both independently and in a team environment.Schedule:Location: Remote anywhereHours: Prefer 12-5PM Pacific time Wed, Thurs, Fri (but would also accept 10AM-5PM Thurs and 8:30-5pm Fri Pacific Time)Noted hours are ideal - can be flexible for strong candidates but must discuss first.Send qualified interested CV's to Dave Friedman at [email protected]. Contact: [email protected] job and many more are available through The Judge Group. Find us on the web at www.judge.com

Certification Reviewer Interested in future career opportunities in the product testing industry? Would you like to work for a Global organization that helps make the world a safer place? Intertek, a leading provider of ATIC (Assurance, Testing, Inspection, and Certification) Services, is actively seeking a Certification Reviewer to join our Electrical team in Arlington Heights, IL. By joining Intertek, your contributions will be valued as we continue to help the world Build Back Ever Better. Job Overview The Certification Reviewer will be responsible for a full range of general support, administrative and coordination duties as well as Report Review and ATM processing for our Certification Department. This position requires a person with strong communication skills, excelling in computer program knowledge and navigation, works independently within a supportive team and will be responsible for ensuring timely and accurate completion of Certification and Surveillance Services functions. Scope of Work Report Reviews & Workflow processing of listed product reports submitted by Engineering. Provide customer support/service, i.e., respond to and help resolve inquiries/complaints/issues from Engineering/Operations Teams and other Certification Staff Delivery of ATMs and other reports to clients (Systematically) Determine creative solutions to solve problems and streamline results. Analyze and evaluate data and complete steps necessary to provide solutions and close projects. Plan, implement, coordinate, monitor, and evaluate specific administrative programs as assigned. Ensure that electronic project and client files and databases are maintained/administered appropriately. Maintain a high level of confidentiality and using discretion when necessary. Participate in the development and implementation of business goals and objectives. Analyze, define and implement new and effective processes to increase efficiency and customer experience. Attend status meetings to discuss progress. Assist with forecasting and month end reports. Essential Requirements High School Diploma, or equivalent; associate degree in business preferred. 2+ years of administrative experience Ability to work independently within a supportive team, in a fast-paced environment. Ability to multi-task, pay attention to detail and type quickly and accurately. Ability to analyze and solve problems. Microsoft Office software expertise, using multiple programs at once. Demonstrated experience starting up new processes and programs. Excellent communication and customer service skills; written and verbal. Excellent organization and time management skills Ability to communicate effectively in a global organization with remote business partners. Performing general emailing, faxing, scanning, copying, mailing, etc. Ability to travel up to 15% as business dictates. Why Work for Intertek? Intertek is a world leader in the $250 billion Quality Assurance market, with a proven, high-quality business model and a global network of customer-focused operations and highly engaged subject matter experts. At Intertek, we exercise our spirit of innovation, the passion of our people and our unmatched customer commitment to realize our purpose of making the world an ever better, safer, and more sustainable place for all. Learn more about Our History and What We Do . What We Have to Offer When working with Intertek , you can expect salary and benefit package competitively placed within the local market, including: Fully comprehensive benefits package; Medical, Dental, Vision, Life, and Disability 401(k) with company matching Competitive market pay Generous vacation/sick time (PTO) Employee referral bonus Tuition reimbursement and much more. Intertek is a drug-free workplace. As a condition of employment, all hires are required to pass a pre-employment drug test.Intertek believes that Our People are our strongest tool for success. We are an Equal Opportunity Employer and do not discriminate against applicants due to veteran status or on the basis of disability. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, or gender identity.Apply directly on our website: Intertek US Careers (oraclecloud.com) For individuals with disabilities who would like to request an accommodation, or who need assistance applying, please email [email protected] or call 1-877-694-8543 (option #5) to speak with a member of the HR Department.#LI-AR1CA-ARIntertek is a leading Total Quality Assurance provider to industries worldwide. Our network of more than 1,000 laboratories and offices in more than 100 countries, delivers innovative and bespoke Assurance, Testing, Inspection and Certification (ATIC) solutions for our customers' operations and supply chains. Working at Intertek means joining a global network of state-of-the-art facilities and passionate people who deliver superior customer service with a purpose of bringing quality, safety, and sustainability to life.

Description Reviewer - Therapy Services Location: Remote within 50 miles of pulse point in California (Cerritos, Costa Mesa, Los Angeles, Palo Alto, Rancho Cordova, Sacramento, Walnut Creek, Woodland Hills) Hours: Monday - Friday from 9:30 am - 6:00 pm PST The Reviewer -Therapy Services is responsible for the review of medical records to determine if requests for therapy services (physical therapy, occupational therapy, and/or speech-language pathology) were medically necessary and filed appropriately. How you will make an impact: Follows the system guidelines that makes decisions on approval for care for a patient. Processes system generated decisions for authorization requests, meeting all contract requirements, processes, and operational unit goals to ensure customer satisfaction. Documents findings, develops analyses, and submits reports to the appropriate departments in accordance with government regulations and requirements. Researches and obtains additional data, consults with clinical reviewers and medical directors, when necessary. Acts as a resource for internal and external customers. May participate in intradepartmental teams, projects, and initiatives. Maintains quality and productivity standards and ensures reviews are conducted within required timeframes. Minimum Requirements: Requires graduate of a college level program in physical therapy, occupational therapy, or speech language pathology or an accredited two-year program for a Physical Therapist Assistant, Occupational Therapist Assistant, or Speech Language Pathologist Assistant and minimum of 1 year of clinical experience; or any combination of education and experience, which would provide an equivalent background. Current active unrestricted license or certification as a physical therapist assistant, occupational therapist assistant, or speech language pathologist assistant in applicable state required. Certification and/or licensure appropriate to field of specialty is required. Preferred Skills, Capabilities, and Experiences: For URAC accredited areas the following applies: Requires current, active, unrestricted license in occupational, speech, or physical therapy to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States. Unless expressly allowed by state or federal law or regulation, are located in a state or territory of the United States when conducting a peer clinical review. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. **** For candidates working in person or remotely in the below locations, the salary* range for this specific position is $31.18 to $51.02 Locations : California In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] assistance.

Remote, Nationwide - Seeking Medical Content Reviewer Everybody Has A Role To Play In Accelerating Healthcare Innovation If you want to be part of changing healthcare to better serve patients, you are in the right place. With Inflect Health you will join a team of individuals dedicated to optimizing healthcare for all. Join the Inflect Health Team. At Inflect Health, Vituity's Innovation Hub, we identify, develop, and invest in leading-edge technologies and solutions that strengthen Vituity's history of healthcare transformation. When you join our team, you are part of a community that is committed to sharing the future of healthcare by prioritizing the human element in innovation - focusing on the provider and patient outcomes, not just the technology. The Opportunity Craft expert responses, showcasing your deep knowledge of medical principles to enhance machine learning of healthcare data. Analyze samples based on provided information, demonstrating your ability to apply your expertise effectively. Evaluate samples in sequential descending priority in a multi-step project, which will be used as inputs for a model. Required Experience and Competencies Resume and cover letter required upon applying. Eligibility to work in the U.S. Expertise and experience in healthcare. Experience using G-Suite (e.g. Google Sheets, etc.). English language proficiency. Salary rate for this role is $60 per hour. Please speak with a recruiter for more information. Innovation and transformation are required to navigate and improve the evolving landscape of healthcare, and we believe everyone can play a role in that. We strive to be a catalyst for that transformation through improvement in healthcare delivery and the development of health technologies. If you want to make a difference, Inflect Health is the place to do it. Inflect Health appreciates differences; our dedication to diversity, equity and inclusion is at the heart of our organization. Inflect Health does not discriminate against any person on the basis of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information (including family medical history), veteran status, marital status, pregnancy or related condition, or any other basis protected by law. Inflect Health is committed to complying with all applicable national, state and local laws pertaining to nondiscrimination and equal opportunity. Applicants only. No agencies please.

Description Reviewer - Therapy Services Location : 50 miles of a Pulse Point in PST or MST Hours: Will vary based on your time zone 6:00 am - 2:30 pm or 8:30am - 5:00 pm PST 7:00 am - 3:30 pm or 9:30am - 6:00 pm MST The Reviewer - Therapy Services is responsible for the review of medical records to determine if requests for therapy services (physical therapy, occupational therapy, and/or speech-language pathology) were medically necessary and filed appropriately. How you will make an impact: Follows the system guidelines that makes decisions on approval for care for a patient. Processes system generated decisions for authorization requests, meeting all contract requirements, processes, and operational unit goals to ensure customer satisfaction. Documents findings, develops analyses, and submits reports to the appropriate departments in accordance with government regulations and requirements. Researches and obtains additional data, consults with clinical reviewers and medical directors, when necessary. Acts as a resource for internal and external customers. May participate in intradepartmental teams, projects, and initiatives. Maintains quality and productivity standards and ensures reviews are conducted within required timeframes. Minimum Requirements: Requires graduate of a college level program in physical therapy, occupational therapy, or speech language pathology or an accredited two-year program for a Physical Therapist Assistant, Occupational Therapist Assistant, or Speech Language Pathologist Assistant and minimum of 1 year of clinical experience; or any combination of education and experience, which would provide an equivalent background. Current active unrestricted license or certification as a physical therapist assistant, occupational therapist assistant, or speech language pathologist assistant in applicable state required. Certification and/or licensure appropriate to field of specialty is required. Preferred Skills, Capabilities, and Experiences: For URAC accredited areas the following applies: Requires current, active, unrestricted license in occupational, speech, or physical therapy to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States. Current, active, unrestricted license or certification as a physical therapist assistant, occupational therapist assistant, or speech language pathologist assistant in applicable state or territory of the United States. Unless expressly allowed by state or federal law or regulation, are located in a state or territory of the United States when conducting a peer clinical review. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. Home Health experience highly preferred For candidates working in person or remotely in the below locations, the salary* range for this specific position is $28.62 to $51.52 Locations : California; Colorado; Nevada; Washington State In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] assistance.

Description Reviewer - Therapy Services Location: Remote within 50 miles of pulse point in the following locations: California Washington Nevada Idaho Hours: Monday - Friday from 9:30 am - 6:00 pm PST The Reviewer -Therapy Services is responsible for the review of medical records to determine if requests for therapy services (physical therapy, occupational therapy, and/or speech-language pathology) were medically necessary and filed appropriately. How you will make an impact: Follows the system guidelines that makes decisions on approval for care for a patient. Processes system generated decisions for authorization requests, meeting all contract requirements, processes, and operational unit goals to ensure customer satisfaction. Documents findings, develops analyses, and submits reports to the appropriate departments in accordance with government regulations and requirements. Researches and obtains additional data, consults with clinical reviewers and medical directors, when necessary. Acts as a resource for internal and external customers. May participate in intradepartmental teams, projects, and initiatives. Maintains quality and productivity standards and ensures reviews are conducted within required timeframes. Minimum Requirements: Requires graduate of a college level program in physical therapy, occupational therapy, or speech language pathology or an accredited two-year program for a Physical Therapist Assistant, Occupational Therapist Assistant, or Speech Language Pathologist Assistant and minimum of 1 year of clinical experience; or any combination of education and experience, which would provide an equivalent background. Current active unrestricted license or certification as a physical therapist assistant, occupational therapist assistant, or speech language pathologist assistant in applicable state required. Certification and/or licensure appropriate to field of specialty is required. Preferred Skills, Capabilities, and Experiences: For URAC accredited areas the following applies: Requires current, active, unrestricted license in occupational, speech, or physical therapy to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States. Unless expressly allowed by state or federal law or regulation, are located in a state or territory of the United States when conducting a peer clinical review. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. **** For candidates working in person or remotely in the below locations, the salary* range for this specific position is $30.05 to $51.52 Locations : California, Nevada, Washington State In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] assistance.

The rewards at Healogics are immense, starting with the important work we do to change patients' lives. We also understand that meaningful work is hard work, and we are committed to supporting and compensating our employees for the tremendous service they provide.Think you are a great fit? Learn more about this role here:Healogics Wound Care Supply, LLC ("HWCS") is a subsidiary entity of Healogics, LLC ("Healogics") who is the largest provider of advanced wound care services in the United States, treating more than 300,000 chronic wound patients annually across over 600 sites. With an aging society, obesity and diabetes on the rise, and an uptick in surgical procedures, the number of patients with non-healing wounds that would benefit from expert care is dramatically increasing. As a result, Healogics - via its family of companies - is working to provide our differentiated, quality outcomes to as many patients that would benefit through our out-patient clinic partnerships.The Medical Records Analyst & Educator is a member of HWCS' Healogics Documentation Team who works closely with outside vendors and / or customers as well as internal HWCS staff and employees of other Healogics entities. The duties and responsibilities of the Medical Records Analyst & Educator include analysis of medical records to support daily claims analysis and "scrubbing" of claims against relevant payor criteria for coverage. This includes Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) associated with Medicare and its Medicare Administrative Contractors (MACs) as well as coverage guidance provided by other governmental payors and private payor entities. The Medical Records Analyst & Educator is responsible for collection, validation, and analysis of patient information applicable to specific DME or other supply orders and referencing internal and external guidance material which identifies documentation necessary from the medical record for "scrubbing" of the claim associated with the order. The Medical Records Analyst & Educator is also responsible for reconciliation of "missing documentation" reports for claims under review and education of clinical staff and patient navigators with respect to why said information necessary for the review of a particular claim. From time to time, the Medical Records Analyst & Educator also will be required to compile data and otherwise assist in reporting and auditing related to activities of the Healogics Documentation Team.Due to the requirement to routinely access medical records, this position requires a familiarity and compliance with the Health Insurance Portability and Accountability Act ("HIPAA") as well as similar state laws. This position requires a general familiarity with electronic medical record ("EMR") systems. Healogics has its own EMR system - i-heal. Training specific as to the use of this system will be provided.This position requires familiarity a variety of coverage determination publications from governmental and private payors and maintaining familiarity as updated materials on such coverage determinations are published. In instances where guidance material is unclear or conflicting, the Medical Records Analyst & Educator must be able to interpret available material and provide a written opinion as to coverage based on facts related to a specific situation. A basic understanding of medical terminology and working familiarity with Medicare LCDs and NCDs is required. Training as to updated coverage determination materials and new payors with which the Medical Records Analyst & Educator are expected to be familiar will be provided.The Medical Records Analyst & Educator will understand and fully support the mission, vision, and value statements of HWCS and the Healogics family of companies. The Medical Records Analyst & Educator contributes directly to the Healogics Key Result of "Grow the Business" by assisting in the process of efficient claims management and indirectly to the Healogics Key Result of "Exceptional Patient Experience" by ensuring that patient claims are handled promptly and accurately.All HWCS employees must perform their job responsibilities according to all company policies, as well as hospital policies, policies of accrediting organizations, federal and state regulations, and guidelines of the Centers for Medicare and Medicaid Services (CMS), as applicable.Essential Functions/ResponsibilitiesReview order packets for DME or supplies as compiled by the Medical Records Processor. Confirm relevant payor for the order. Confirm documentation provided is complete based on the requirements of the payor and DME / supply ordered. Return incomplete order packets to the Medical Records Processor and identify what documentation is missing. As necessary, work with Medical Records Processor to contact and educate accounts regarding missing documentation. The Medical Records Analyst & Educator may be required to educate center-based staff when data required by a payor to process a DME / supply order is missing from documentation, i.e., progress notes or wound assessments missing data such as duration of need, quantity used per day, total quantity used, etc. The Medical Records Processor should engage in continued contact to ensure supplemental data or documentation is received once education has been provided. Engage in formal and informal education to wound care center-based staff, including patient navigators, case manager, clinical nurse managers, and providers as to documentation and data necessary for review of DME / supply orders based on the coverage requirements of specific payors. Analyze order packets based on the identified payor and their associated coverage determination guidance. Classify order packets as (i) clearly meets payor guidance as to medical necessity, (ii) based on reviewer's opinion, meets payor guidance as to medical necessity (with written opinion), (iii) clearly does not meet payor guidance as to medical necessity, or (iv) based on reviewer's opinion, does not meet payor guidance as to medical necessity. For determinations in categories (ii) and (iv), meet with DME Documentation & Education Manager and / or other individuals within Healogics who have expertise as to payor coverage determinations and confer as to final position as to medical necessity based on the specific payor and DME / supply ordered. Ensure proper documentation of consensus opinion. Upload and maintain collected analysis and determination documents in HWCS' Documentation Repository System. Provide routine follow-up to wound care center-based staff to advise of metrics related to initial completeness of documentation for order packets received as well as validation rate for medical necessity requirements. Assist with departmental audits as well as vendor or customer audits. Follow all confidentiality and security requirements as to medical records. Follow all documentation and tracking requirements related to records requests to allow for data analysis of program efficacy and efficiency. Complete administrative duties including answering phones, taking messages, responding to emails, communicating information back to vendors / customers, maintaining necessary logs, and collaborating with fellow team members. Participate in improving quality throughout the company and the Healogics organization. Perform other duties as required.Required Education, Experience And CredentialsAssociates degree from an accredited university or college in business, accounting, finance, healthcare administration or related field or equivalent experienceMinimum of two (2) to four (4) years related experience in health care finance and/or revenue cycle in hospital, physician office or., other related setting.Required Knowledge, Skills And AbilitiesWorking knowledge of DME coding, billing, payor requirements, and denial management. Must have a working knowledge of the Medicare and MAC codes, rules, regulations, pronouncements and applicable Fiscal Intermediary polices (e.g. Local Coverage Determinations). Familiarity with medical terminology. Proficient in Microsoft Suite (Excel, Word, Outlook). Keen attention to detail with the ability to work independently and maintain confidentiality. Ability to collaborate and demonstrate leadership skills in a team environment. Strong interpersonal, written and verbal communication skills with a focus on customer service. Organization, prioritization and time management skills. Working knowledge of systems/applications with indication of those preferred. Demonstrated ability to exhibit integrity and commitment to professional ethics. Budget and long-term planning skills.

The rewards at Healogics are immense, starting with the important work we do to change patients' lives. We also understand that meaningful work is hard work, and we are committed to supporting and compensating our employees for the tremendous service they provide.Think you are a great fit? Learn more about this role here:Healogics is the largest provider of advanced wound care services in the United States, treating more than 300,000 chronic wound patients annually across over 600 sites. With an aging society, obesity and diabetes on the rise, and an uptick in surgical procedures, the number of patients with non-healing wounds that would benefit from expert care is dramatically increasing. As a result, the company is working to provide our differentiated, quality outcomes to as many patients that would benefit through our out-patient clinic partnerships.The Medical Records Analyst & Educator is a member of HWCS' Healogics Documentation Team who works closely with outside vendors and / or customers as well as internal HWCS staff and employees of other Healogics entities. The duties and responsibilities of the Medical Records Analyst & Educator include analysis of medical records to support daily claims analysis and "scrubbing" of claims against relevant payor criteria for coverage. This includes Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) associated with Medicare and its Medicare Administrative Contractors (MACs) as well as coverage guidance provided by other governmental payors and private payor entities. The Medical Records Analyst & Educator is responsible for collection, validation, and analysis of patient information applicable to specific DME or other supply orders and referencing internal and external guidance material which identifies documentation necessary from the medical record for "scrubbing" of the claim associated with the order. The Medical Records Analyst & Educator is also responsible for reconciliation of "missing documentation" reports for claims under review and education of clinical staff and patient navigators with respect to why said information necessary for the review of a particular claim. From time to time, the Medical Records Analyst & Educator also will be required to compile data and otherwise assist in reporting and auditing related to activities of the Healogics Documentation Team.Due to the requirement to routinely access medical records, this position requires a familiarity and compliance with the Health Insurance Portability and Accountability Act ("HIPAA") as well as similar state laws. This position requires a general familiarity with electronic medical record ("EMR") systems. Healogics has its own EMR system - i-heal. Training specific as to the use of this system will be provided.This position requires familiarity a variety of coverage determination publications from governmental and private payors and maintaining familiarity as updated materials on such coverage determinations are published. In instances where guidance material is unclear or conflicting, the Medical Records Analyst & Educator must be able to interpret available material and provide a written opinion as to coverage based on facts related to a specific situation. A basic understanding of medical terminology and working familiarity with Medicare LCDs and NCDs is required. Training as to updated coverage determination materials and new payors with which the Medical Records Analyst & Educator are expected to be familiar will be provided.The Medical Records Analyst & Educator will understand and fully support the mission, vision, and value statements of HWCS and the Healogics family of companies. The Medical Records Analyst & Educator contributes directly to the Healogics Key Result of "Grow the Business" by assisting in the process of efficient claims management and indirectly to the Healogics Key Result of "Exceptional Patient Experience" by ensuring that patient claims are handled promptly and accurately.All HWCS employees must perform their job responsibilities according to all company policies, as well as hospital policies, policies of accrediting organizations, federal and state regulations, and guidelines of the Centers for Medicare and Medicaid Services (CMS), as applicable.Essential Functions/ResponsibilitiesReview order packets for DME or supplies as compiled by the Medical Records Processor. Confirm relevant payor for the order. Confirm documentation provided is complete based on the requirements of the payor and DME / supply ordered. Return incomplete order packets to the Medical Records Processor and identify what documentation is missing. As necessary, work with Medical Records Processor to contact and educate accounts regarding missing documentation. The Medical Records Analyst & Educator may be required to educate center-based staff when data required by a payor to process a DME / supply order is missing from documentation, i.e., progress notes or wound assessments missing data such as duration of need, quantity used per day, total quantity used, etc. The Medical Records Processor should engage in continued contact to ensure supplemental data or documentation is received once education has been provided. Engage in formal and informal education to wound care center-based staff, including patient navigators, case manager, clinical nurse managers, and providers as to documentation and data necessary for review of DME / supply orders based on the coverage requirements of specific payors. Analyze order packets based on the identified payor and their associated coverage determination guidance. Classify order packets as (i) clearly meets payor guidance as to medical necessity, (ii) based on reviewer's opinion, meets payor guidance as to medical necessity (with written opinion), (iii) clearly does not meet payor guidance as to medical necessity, or (iv) based on reviewer's opinion, does not meet payor guidance as to medical necessity. For determinations in categories (ii) and (iv), meet with DME Documentation & Education Manager and / or other individuals within Healogics who have expertise as to payor coverage determinations and confer as to final position as to medical necessity based on the specific payor and DME / supply ordered. Ensure proper documentation of consensus opinion. Upload and maintain collected analysis and determination documents in HWCS' Documentation Repository System. Provide routine follow-up to wound care center-based staff to advise of metrics related to initial completeness of documentation for order packets received as well as validation rate for medical necessity requirements. Assist with departmental audits as well as vendor or customer audits. Follow all confidentiality and security requirements as to medical records. Follow all documentation and tracking requirements related to records requests to allow for data analysis of program efficacy and efficiency. Complete administrative duties including answering phones, taking messages, responding to emails, communicating information back to vendors / customers, maintaining necessary logs, and collaborating with fellow team members. Participate in improving quality throughout the company and the Healogics organization. Perform other duties as required.Required Education, Experience And CredentialsAssociates degree from an accredited university or college in business, accounting, finance, healthcare administration or related field or equivalent experienceMinimum of two (2) to four (4) years related experience in health care finance and/or revenue cycle in hospital, physician office or., other related setting.Required Knowledge, Skills And AbilitiesWorking knowledge of DME coding, billing, payor requirements, and denial management. Must have a working knowledge of the Medicare and MAC codes, rules, regulations, pronouncements and applicable Fiscal Intermediary polices (e.g. Local Coverage Determinations). Familiarity with medical terminology. Proficient in Microsoft Suite (Excel, Word, Outlook). Keen attention to detail with the ability to work independently and maintain confidentiality. Ability to collaborate and demonstrate leadership skills in a team environment. Strong interpersonal, written and verbal communication skills with a focus on customer service. Organization, prioritization and time management skills. Working knowledge of systems/applications with indication of those preferred. Demonstrated ability to exhibit integrity and commitment to professional ethics. Budget and long-term planning skills.The salary for this position generally ranges between $44,800.00 - $66,300.00 AnnuallyThis range is an estimate, based on potential employee qualifications: education, experience, geography as well as operational needs and other considerations permitted by law.If you are a current employee, to submit a job application, you need to apply as an internal candidate in Workday via the "Jobs Hub".

Remote, Nationwide - Seeking Medical Content Reviewer Everybody Has A Role To Play In Accelerating Healthcare Innovation If you want to be part of changing healthcare to better serve patients, you are in the right place. With Inflect Health you will join a team of individuals dedicated to optimizing healthcare for all. Join the Inflect Health Team. At Inflect Health, Vituity's Innovation Hub, we identify, develop, and invest in leading-edge technologies and solutions that strengthen Vituity's history of healthcare transformation. When you join our team, you are part of a community that is committed to sharing the future of healthcare by prioritizing the human element in innovation - focusing on the provider and patient outcomes, not just the technology. The Opportunity Craft expert responses, showcasing your deep knowledge of medical principles to enhance machine learning of healthcare data. Analyze samples based on provided information, demonstrating your ability to apply your expertise effectively. Evaluate samples in sequential descending priority in a multi-step project, which will be used as inputs for a model. Required Experience and Competencies Resume and cover letter required upon applying. Eligibility to work in the U.S. Expertise and experience in healthcare. Experience using G-Suite (e.g. Google Sheets, etc.). English language proficiency. Salary rate for this role is $35 - $40 per hour. Please speak with a recruiter for more information. Innovation and transformation are required to navigate and improve the evolving landscape of healthcare, and we believe everyone can play a role in that. We strive to be a catalyst for that transformation through improvement in healthcare delivery and the development of health technologies. If you want to make a difference, Inflect Health is the place to do it. Inflect Health appreciates differences; our dedication to diversity, equity and inclusion is at the heart of our organization. Inflect Health does not discriminate against any person on the basis of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information (including family medical history), veteran status, marital status, pregnancy or related condition, or any other basis protected by law. Inflect Health is committed to complying with all applicable national, state and local laws pertaining to nondiscrimination and equal opportunity. Applicants only. No agencies please.