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Senior Nurse Reviewer
Jobgether
On-siteHealthcare
From the original posting
US Accountabilities: You will conduct comprehensive clinical and billing reviews to verify the accuracy, appropriateness, and validity of healthcare claims while maintaining established productivity and quality standards. Review medical claims using UB-04 forms and detailed itemized statements to validate individual charges. Verify itemized medical bill charges against client policies, applicable requirements, and industry standards. Perform utilization and level-of-care reviews by analyzing medical records and applying established criteria to assess the appropriateness and reasonableness of…
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