UNKNOWN

FEED

Job Summary: Claims Clinical Documentation Reviewer reports to the Prepayment Program Manager and is responsible for reviewing clinical and/or supportive documentation, submitted by provider organizations, in support of billed medical, behavioral health, NEMT and other related Medicaid services by applying knowledge of healthcare State, Federal, and AHCCCS laws, policies, and practices. frame-loader#lazyLoad clinch:authenticated@document->frame-loader#reload" data-controller="frame-loader" data-src="/blocks/jobs/565efbb6ebf8a9e0cab92f2375869e2d/favourites?page_id=ce80aad5135a1a199e8bf76b3efdd0be" id="565efbb6ebf8a9e0cab92f2375869e2d_favourites">.

YEAR

State of Arizona

Claims Clinical Documentation Reviewer

linkup_via_bold

Together we share insights, use the latest technologies and apply advanced business practices to speed our customers' delivery of important therapies to patients. Selecting us as an employer secures a career in which you're guaranteed to: Collaborate with passionate problem solvers Partner with the most diverse team of experts in the industry.

Syneos Health Inc

Clinical Data Reviewer (Canada or US) Oncology

We are passionate about developing our people, through career development and progression; supportive and engaged line management; technical and therapeutic area training; peer recognition and total rewards program. Our Clinical Solutions team members act with a drug development mindset, applying their years of experience and deep expertise to truly understand customer needs and represent those in the solutions we shape.

Syneos Health

Clinical Data Reviewer

sourcestack_via_bold

Participate in improving organizational performance through recommending areas or approaches for improvement activities, performing new procedures, collecting data, and providing input to department discussions. Quality Improvement - Supervise and coordinate quality improvement efforts, either within the department or within a larger quality assessment team, related to data collection and reporting.

Cincinnati Children's Hospital Medical Center

Clinical Reviewer

OTHER

In CCK’s partnership with the US Oncology Network, one of the nation’s largest networks of community-based oncology physicians dedicated to advancing cancer care in America and supported by McKesson Corporation, we are able to extend an extremely competitive offering of benefits to employees, including: Contacts insurance companies through effectively navigating company websites, managed care portals and through methods such as phone and fax in order to complete prior authorization information requests for ordered services.

Cancer Center of Kansas

Insurance Reviewer - Clinical

[AW]-iCims

While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Responsibilities: Reviews, processes and audits the medical necessity for treatments including radiation oncology, gynecologic surgery, genetic lab testing, imaging, and chemotherapy treatment for each patient.

HOUR

Willamette Valley Cancer Institute & Research Center

Prior Authorization Specialist/Insurance Reviewer - Clinical

Acting as a subject matter expert in pharmacy benefit management, this role interprets complex drug criteria, formulary guidelines, step therapy, and quantity limits for specialty and non-specialty medications. The Clinical Pharmacy Reviewer (Pharmacist) evaluates complex prior authorization requests, appeals, and medication coverage determinations to ensure clinical appropriateness and compliance with evidence-based guidelines.

Dane Street

Clinical Pharmacy Reviewer (Pharmacist) - Remote

4- 6 years previous relevant experience in clinical documentation, or CDI second level review or inpatient coding quality review and/or DRG validation with a strong understanding of disease processes, clinical indications and treatments; provider documentation requirements to reflect severity of illness, risk of mortality and support the diagnosis/procedures performed for accurate clinical coding and billing according the rules of Medicare, Medicaid, and commercial payors as well as a solid understanding of hospital acquired conditions (HAC’s), patient safety indicators (PSI’s) and mortality models. Duties: Analyzes and interprets clinical data to identify gaps, inconsistencies, and/or opportunities for improvement in the clinical documentation and queries the provider using concurrent query process following ACDIS/AHIMA Guidelines for Compliant Query Writing.

Guidehouse

Second Level Reviewer-Clinical Documentation Integrity

Review pediatric clinical documentation and patient charts for accuracy, completeness, and clinical soundness. For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome.

Mercor

Pediatrician MD - Clinical Reviewer

Manatal

For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome. Highly proficient in Microsoft Office and Google Workspace , especially Slides .

Clinical Reviewer - Fully Remote

For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome. Mercor connects elite creative and technical talent with leading AI research labs.

Healthcare Expert - Clinical Reviewer

Special Requirement - Do you possess an active license issued by the Pennsylvania Bureau of Professional and Occupational Affairs to practice as a Social Worker, Clinical Social Worker, Marriage and Family Therapist, Professional Counselor, Psychologist, Registered Nurse, Certified Registered Nurse Practitioner, or Clinical Nurse Specialist?. SOMEONE ELSE was responsible for recommending referrals for emergency, urgent, or routine professional psychiatric, behavioral, intellectual disabilities, or autism treatment services AND conducting follow- ups of referrals with clients and providers to ensure adequate care was received.

Commonwealth of Pennsylvania

Clinical Care Reviewer (County Care Management Manager) - Fayette County MH/ID

Cincinnati Children’s Hospital

Clinical Registry Reviewer

Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Inpatient Coder (CIC), Clinical Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC), or other advanced HIM/coding certifications. At least 2 years of experience in inpatient payment integrity medical claim review including DRG validation or itemized bill review, and experience working with ICD-10, MS-DRG, AP-DRG and APR-DRG, CPT, HCPCS, or equivalent combination of relevant education and experience.

Molina Healthcare Inc

Clinical Validation Reviewer (RN)

Provides second-level reviews of clinical documentation of concurrent and retrospective documentation as it relates to Patient Safety Indicators (PSI), Hospital Acquired Conditions (HAC), payer denials, working DRG and final DRG mismatches, mortality reviews, and other appropriate second-levels. SUMMARY: Works with physicians, HIM (Health Information Management), Clinical Documentation Integrity (CDI) team members, ancillary staff, and multidisciplinary team members to improve the quality, and completeness of documentation of the patient's clinical condition and treatment provided for designated populations.

Tucson Medical Center

RN Clinical Documentation Integrity Second-Level Reviewer

You will: Review clinical data remotely and identify errors, systemic issues and trends related to data integrity, participant safety and site performance. You will join a widespread, yet closely-knit team with the same mentality and desire to develop smart and intelligent approach to project monitoring.

ea_via_bold

The ideal candidate is detail-oriented with strong applied clinical knowledge and an interest in improving outcomes in autism/ABA services, enabling data-driven decision making, developing operational efficiencies, and AI-enabled healthcare solutions. In this role, you’ll report directly to our Senior Vice President of Clinical Operations and work alongside the clinical and product teams to validate system outputs, support enhancements, and make modifications to our platform.

Onos Health

Clinical Quality Reviewer - BCBA

Leveraging advanced practice provider clinical judgment, this role evaluates whether medical records contain sufficient clinical evidence to support reported diagnoses, identifies documentation and compliance risks, and delivers peer-level education to improve documentation accuracy, specificity, and defensibility. Employees in safety-sensitive positions are subject to drug and alcohol testing, including for substances that may impair judgment or motor function, in accordance with applicable federal and state laws and company policy.

WellBe Senior Medical

APP Clinical Documentation Integrity Reviewer

Weekend support: Our agencies run seven days a week, so we ask each reviewer to pitch in for weekend shifts to keep care plans moving smoothly. Flexibility: Lehi HQ or fully remote within the U.S. Mission-Driven Culture: Work alongside passionate founders and nursing team in a collaborative, low-ego environment.

Enzo Health

PRN Clinical Quality Reviewer: Home Health Coding & OASIS

Analyzes and interprets clinical data to identify gaps, inconsistencies, and/or opportunities for improvement in the clinical documentation and queries the provider using concurrent query process following ACDIS/AHIMA Guidelines for a Compliant Query Practice. Collaborates with physicians and/or other clinicians to enhance understanding of the CDI program goals; ensures the medical record can be coded accurately in order to accurately reflect patient severity of illness and risk of mortality.

Clinical Reviewer Jobs in the United States

Claims Clinical Documentation Reviewer State of Arizona

Clinical Data Reviewer (Canada or US) Oncology Syneos Health Inc

Clinical Data Reviewer Syneos Health

Clinical Reviewer Cincinnati Children's Hospital Medical Center

Insurance Reviewer - Clinical Cancer Center of Kansas

Prior Authorization Specialist/Insurance Reviewer - Clinical Willamette Valley Cancer Institute & Research Center

Clinical Pharmacy Reviewer (Pharmacist) - Remote Dane Street

Second Level Reviewer-Clinical Documentation Integrity Guidehouse

Pediatrician MD - Clinical Reviewer Mercor

Clinical Reviewer - Fully Remote Mercor

Healthcare Expert - Clinical Reviewer Mercor

Clinical Care Reviewer (County Care Management Manager) - Fayette County MH/ID Commonwealth of Pennsylvania

Clinical Registry Reviewer Cincinnati Children’s Hospital

Clinical Validation Reviewer (RN) Molina Healthcare Inc

RN Clinical Documentation Integrity Second-Level Reviewer Tucson Medical Center

Clinical Data Reviewer PSI

Clinical Quality Reviewer - BCBA Onos Health

APP Clinical Documentation Integrity Reviewer WellBe Senior Medical

PRN Clinical Quality Reviewer: Home Health Coding & OASIS Enzo Health

Clinical Documentation Quality Reviewer (Remote) Memorial Hermann Health System

Similar Job Searches

See More Jobs

Stand out to leading employers.