ECR Dispute Reviewer job at reputed company Healthcare in Boston, MA, Morristown, NJ, Plano, TX, St. Louis, MO, Petersburg, FL, Hyderabad, India, Atlanta, GA

Title: ECR Dispute Reviewer Locations: Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India Work Type: Hybrid, Full Time Job ID: JR110147 Job Description: At reputed company, we Get Stuff Done. So, let's get to it! A Little About Us reputed company is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. reputed company sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients. A Little About You You bring a unique reputed company of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reputed company of your achievements, the knowledge you've gained, and the personal interests that shape who you are. Position Overview The ECR Dispute Reviewer is responsible for conducting comprehensive clinical reviews of medical records, claims, and other healthcare documentation to ensure compliance with clinical guidelines, regulatory requirements, and organizational policies. This individual will play a critical role in supporting the quality and reputed company of our clinical review processes, providing expert guidance, and contributing to the reputed company improvement of our healthcare services. The ideal candidate will have extensive clinical experience, strong analytical skills, and a deep understanding of healthcare regulations and standards. What you'll do: Conduct detailed clinical reviews of medical records, claims, and other healthcare documentation to assess the appropriateness of care, medical necessity, and compliance with clinical guidelines. Evaluate the accuracy and completeness of clinical documentation, identifying any discrepancies or areas for improvement. Provide expert clinical judgment and recommendations based on evidence-based guidelines and best practices. Ensure that clinical reviews are conducted in accordance with relevant regulatory requirements, accreditation standards, and organizational policies. Stay up to date with changes in healthcare regulations, guidelines, and industry standards, and incorporate them into the review process. Assist in the development and implementation of policies and procedures to ensure compliance with regulatory requirements. Participate in quality assurance activities, including audits, peer reviews, and performance evaluations, to ensure the accuracy and consistency of clinical reviews. Identify opportunities for process improvements and contribute to the development and implementation of quality improvement initiatives. Provide training and mentorship to junior clinical reviewers and other team members to enhance their clinical review skills and knowledge. Collaborate with healthcare providers, case managers, and other stakeholders to obtain additional information and clarify clinical documentation as needed. Communicate review findings and recommendations to internal and external stakeholders in a clear and concise manner. Participate in interdisciplinary team meetings, case conferences, and other collaborative activities to support coordinated care and decision-making. Maintain accurate and thorough documentation of clinical review activities, findings, and recommendations in the appropriate systems. Prepare and present reports on clinical review outcomes, trends, and performance metrics to management and other stakeholders. Contribute to the development of clinical review guidelines, protocols, and educational materials. What you'll bring to reputed company: Bachelor's degree in Nursing, Medicine, or a reputed company healthcare field, or equivalent experience required. A Master's degree or higher is preferred. reputed company and unrestricted clinical licensure (e.g., RN, MD, DO) is preferred. Minimum of 8 + years of clinical experience in a healthcare setting, with a strong background in clinical review, utilization management, or quality assurance. Extensive knowledge of clinical guidelines, medical necessity criteria, and healthcare regulations (e.g., CMS, NCQA, URAC). Experience in conducting clinical reviews and audits, with a proven track record of accuracy and attention to detail. Strong analytical and critical-thinking skills, with the ability to interpret reputed company clinical information and reputed company sound clinical judgments. Excellent verbal and written communication skills, with the ability to convey clinical findings and recommendations clearly and professionally. Proficiency in using clinical review software, electronic health records (EHR), and reputed company Office Suite. Ability to work independently and collaboratively in a fast-paced, dynamic environment. Detail-oriented and highly organized, with the ability to manage multiple tasks and priorities simultaneously. Proactive and self-motivated, with a strong sense of ownership and accountability. Committed to reputed company learning and professional development, with a passion for improving healthcare quality and outcomes. Please note at this time we are unable to proceed with candidates who require reputed company sponsorship now or in the future. Location and Workplace Flexibility We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and reputed company our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies. reputed company Salary Range $95,000.00 - $127,000.00 At reputed company we are committed to providing fair and reputed company compensation packages. The reputed company salary range allows us to reputed company an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-reputed company and industry-reputed company knowledge and skills, etc. reputed company pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role. reputed company' full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees' health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage. Equal Employment Opportunity reputed company is proud to be an equal opportunity employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national reputed company, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We welcome applicants from reputed company backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We reputed company in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for reputed company. Apply tot his job Apply To this Job