8 Utilization Review Jobs

Job Summary Responsible for managing and coordinating the complete process of prior authorization, inpatient and outpatient admission reviews, surgical case approvals, appeals, and denial management. Utilizes IQC and MCG Guidelines to evaluate clinical admissibility and ensure compliance with insurance requirements. Collaborates with providers, nursing staff, and insurance companies to secure timely approvals, improve documentation accuracy, and enhance overall case management efficiency. Key Responsibilities - Review and process prior authorizations for inpatient, outpatient, and surgical cases as per insurance and clinical guidelines. - Assess medical necessity and admission admissibility ...

Role & responsibilities Expenses and other bills checking and posting the entries in Tally ERP Employee claim settlement process as defined in SOP. Central salary, professional fees and honorarium processing. Passing of salary related entries in Tally ERP. Preparation and checking of BRS. Monthly MSME tracker, TDS, purchase and other control trackers. Preparation of utilization reports as per the donor requirements. Assistance in internal audit and statutory audit requirements. Tally ledger scrutiny, and other main accounts domain related work. Coordinating with other state offices for day to day work and reports. Coordinating with vendor management team for assistance in bill payments and r...

Role Summary: Were hiring a Utilization Reviewer with a BHMS/BDS background and 1+ year of experience in utilization review and denial management. Expertise in MCG and InterQual Guidelines is essential. Responsibilities: - Review clinical documentation for medical necessity - Apply MCG and InterQual criteria - Ensure compliance with payer and regulatory standards Requirements: - BHMS/BDS degree (mandatory) - 1+ year in utilization review (denial management) - Strong communication and analytical skills - Proficiency in medical terminology and documentation review Role & responsibilities

As a Certified Medical Coder at Elico Healthcare Services Ltd., your role involves accurately coding medical records, ensuring compliance with coding guidelines, and optimizing revenue. You will review and analyze patient records, assign appropriate codes, and collaborate with healthcare professionals to clarify information. Monitoring coding accuracy and staying updated with coding regulations and standards will also be part of your responsibilities. Key Responsibilities: - Accurately code medical records - Ensure compliance with coding guidelines - Optimize revenue by assigning appropriate codes - Collaborate with healthcare professionals to clarify information - Monitor coding accuracy - ...

Company Description Elico Healthcare Services Ltd. is a trusted and renowned partner in the healthcare industry. We offer tailor-made RCM solutions to hospitals, physician groups, EMS providers, and credentialing and contracting agencies. Promoted by Elico Ltd., a technology leader with six decades of pioneering innovations, our value-based strategies and integrated analytics enhance patient care and improve financial parameters. We operate through strategic business units in Hyderabad, Chennai, and Mysore, with a team of over 850 professionals dedicated to satisfying customer requirements. The Medical Coder will be responsible for accurately interpreting, coding, and summarizing the medical...

MinutestoSeconds is a dynamic organization specializing in outsourcing services, digital marketing, IT recruitment, and custom IT projects. We partner with SMEs, mid-sized companies, and niche professionals to deliver tailored solutions. As a Medical / Insurance Claims Analytics Consultant at MinutestoSeconds, you will have the opportunity to work on various projects aimed at improving healthcare claims processes and enhancing member experiences. **Key Responsibilities:** - Reducing Claims Friction: You will contribute to use cases that have already reduced Medicare claim rejections by 7% and re-submissions by 70%. - Driving Automation: Your role will involve automating pre-authorization and...

Role Overview: Zealie, a fast-growing Medical Billing Services company specializing in the Behavioral Healthcare industry, is seeking a Utilization Review (UR) Representative to play a crucial role in managing and coordinating authorization processes while ensuring compliance with insurance and regulatory requirements. The successful candidate will work closely with clinical teams and insurance providers to advocate for optimal patient care through advanced responsibilities and adherence to strict compliance standards and HIPAA regulations. Key Responsibilities: - Lead and Oversee Authorization Processes: Direct and manage authorization processes for assigned facilities, ensuring timely acqu...

As a Medical Claims Review Senior Analyst/Clinical Supervisor in the Complex Claim Unit, you will provide clinical review expertise for high dollar and complex claims, including facility and professional bills. Your role includes identifying coding and billing errors, ensuring the application of Medical and Reimbursement Policies for cost containment, and identifying cases for potential fraud and abuse. Your major responsibilities will involve evaluating medical information against criteria, benefit plans, and coverage policies to determine the necessity for procedures. In cases where criteria are not met, you will refer to the Medical Director. You will also evaluate itemized bills against ...