This page tracks remote reviewer openings that are location-eligible for Florida.
Open jobs
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Hiring companies this week
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$37 - $100,000
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16 Jobs
14 Companies
Transforming the health of the communities we serve, one person at a time.
• Responsible for independently conducting comprehensive reviews of MS-DRG and APR-DRG coding and clinical documentation to ensure the accuracy of DRG assignment and reimbursement. • Requires advanced expertise in ICD-10-CM/PCS coding and the ability to exercise discretion and professional judgment in assessing complex clinical information, validating diagnosis code assignments, and identifying discrepancies such as coding errors or upcoding. • Operates with significant autonomy in supporting DRG validation reviews and appeals, interpreting regulatory requirements, and making authoritative decisions to ensure compliance with all applicable laws, payer contracts, and organizational policies. • Independently conducts comprehensive MS-DRG and APR-DRG coding and clinical validation reviews, exercising professional judgment to verify ICD-10-CM/PCS assignments, validate clinical diagnoses, identify discrepancies, and apply inpatient reimbursement rules without direct supervision. • Collaborates with the Medical Director on complex cases, providing expert recommendations and influencing review outcomes to ensure clinical accuracy and compliance. • Leads the evaluation of complex cases and proactively identifies opportunities to develop medical policy in the absence of established guidelines, demonstrating discretion and authority in decision-making. • Applies advanced knowledge of coding guidelines and clinical policies throughout the review process, making autonomous determinations regarding coding accuracy and regulatory compliance. • Prepares clear, concise, and well-supported audit findings, referencing authoritative sources such as AHA Coding Clinic and ICD-10 guidelines, approved Centene policies, and adopted clinical guidelines, ensuring recommendations reflect professional expertise. • Evaluates claims and medical records for compliance with state and federal regulations, payer contracts, and company policies, exercising independent judgment in interpreting requirements and resolving ambiguities. • Consistently meets or exceeds established quality and productivity standards while managing priorities and workflow autonomously. • Contributes to strategic initiatives by assisting in the development of audit concepts, identifying new audit opportunities, and selecting claims for review, demonstrating leadership in shaping audit methodologies. • Performs other duties as assigned. Complies with all policies and standards.
• Responsible for utilization review calls within BHS, including precertification, continued stay review, discharge reviews, and retrospective reviews and appeals. • Works closely with business office staff, clinical staff, and physicians to advocate for BHS patients with insurance and managed care companies. • Communicates insurance input to physicians and clinical staff making discharge plans for patients. • Assists clinical staff with assessments as needed, primarily as in a back-up capacity. • Communicates daily with Utilization Review Coordinator, and as needed with business office and admissions staff to understand admissions and transfers, patient benefit information, and precertification status. • Understands health care benefit plan provisions and managed care contracting. • Communicates and coordinates efforts at appealing unfavorable utilization review decisions.
• Conduct comprehensive accessibility reviews of electronic documents, web applications, software interfaces, forms, reports, and other digital content to ensure compliance with Section 508 requirements • Evaluate content against applicable accessibility standards, including Section 508, WCAG, and related federal accessibility requirements • Perform manual and automated accessibility testing using industry-standard tools and assistive technologies • Review Microsoft Office documents, PDF files, web content, and other electronic deliverables for accessibility compliance • Document accessibility findings, deficiencies, risks, and recommendations in accordance with established review procedures and reporting standards • Prepare accessibility assessment reports, compliance documentation, review artifacts, and technical recommendations for project stakeholders • Provide remediation guidance and technical recommendations to developers, content authors, designers, and project teams • Research and interpret accessibility requirements, policies, standards, and best practices to support project implementation efforts • Develop, maintain, and update accessibility review documentation, procedures, checklists, job aids, and related technical materials • Track accessibility review activities, findings, corrective actions, and status updates using project management and issue-tracking tools • Collaborate with project teams to resolve accessibility issues and support successful remediation efforts • Support accessibility compliance reporting, audit preparation activities, and quality assurance reviews • Provide guidance and mentoring to junior staff and project team members regarding accessibility requirements and best practices • Participate in project meetings, requirements reviews, design discussions, and testing activities to ensure accessibility considerations are incorporated throughout the project lifecycle • Support continuous improvement initiatives related to accessibility processes, standards, and compliance monitoring • Ensure compliance with federal accessibility, security, privacy, and documentation requirements
• Review CNA reports for compliance with HUD requirements and industry standards prior to delivery to the client; accountable for QA/QC responsibilities • Evaluate technical accuracy and completeness of building component assessments • Verify cost estimates and replacement reserve analyses • Review property condition descriptions and immediate repair recommendations • Ensure proper use of HUD's CNA e-Tool • Validate remaining useful life calculations for building components • Review photo documentation and supporting materials • Provide feedback and correction requests to CNA preparers • Track review status and meet project deadlines • Achieve billing goals, which may vary depending on project complexity • Training and mentoring staff on inspection and workflow practices • Build direct client relationships in support of sales efforts through servicing the account • Serve as the Project Lead, ensuring all projects are staffed, performed to high standards of quality, and delivered on time • Manage projects being completed by consultants / 1099 Contractors • Ensure projects meet the client's goals and scope expectations
• Reviews medical record documentation to verify clinical indicators and coding issues as related to DRG Validation Audits, Emergency Department Downgrade Audits, Inpatient Level of Care Audits, and Charge Outlier Audits, etc. • Creates detailed appeal letters for denials from payer to support payment of patient claims • Manages Inventory and Follow up on accounts as appropriate • Reviews InterQual/Milliman, coding guidelines and/or payer medical policies related to denied procedures or services and includes criteria in appeals letter as appropriate • Provides feedback to supervisor regarding issues identified for ongoing training to peers and non-clinical staff members • Identifies root causes and trends to share with clients and staff • Works with peers in collaboration of clinical writing situations
• Conduct independent, evidence-based file reviews. • Review patient records and related documentation in alignment with clinical guidelines. • Provide objective, high-quality reports within turnaround timelines. • Maintain compliance with URAC, HIPAA, and internal quality standards.
National Leader of Disability and Medical Review Services.
• Conduct comprehensive and objective medical chart reviews with honesty and integrity. • Produce determinations that are clear, concise, and well-supported by evidence. • Follow MMRO’s review templates, ensuring all required elements are complete and accurate. • Communicate findings in a professional manner using appropriate language and grammar. • Complete assigned reviews within the specified deadlines. • Respond promptly to communications from MMRO staff. • Review and comply with corporate training materials and review standards. • Be receptive to constructive feedback from MMRO’s Medical Director, Associate Medical Director, and Clinical Staff. • Contribute ideas for process improvement and quality enhancement.
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• Conduct comprehensive estimate reviews for services including water mitigation, mold remediation, reconstruction, contents, board-up, abatement, biohazard, and fire damage. • Evaluate estimate documentation in Xactimate, XactAnalysis, Claims Connect, Validate, CMS, and related systems. • Ensure compliance with carrier requirements, internal standards, and industry best practices. • Provide professional and constructive feedback to franchise teams to improve estimating consistency and accuracy. • Communicate with both franchise locations and carrier representatives through various digital platforms. • Monitor trends and performance indicators to help identify training opportunities or process improvements. • Support surge needs during catastrophe events or times of increased volume.
• Testing online sweepstakes registration processes and user journeys • Reviewing sign-up flows, KYC requirements, deposit methods, and bonus activation • Evaluating platform usability, features, and overall user experience • Producing clear, well-structured reviews and editorial content in alignment with standardized templates and guidelines • Ensuring all content aligns with regulatory guidelines • Documenting findings accurately and submitting deliverables on time • Representing Signup Expert and our publishing partners professionally
• Testing online sweepstakes registration processes and user journeys • Reviewing sign-up flows, KYC requirements, deposit methods, and bonus activation • Evaluating platform usability, features, and overall user experience • Producing clear, well-structured reviews and editorial content in alignment with standardized templates and guidelines • Ensuring all content aligns with regulatory guidelines • Documenting findings accurately and submitting deliverables on time • Representing Signup Expert and our publishing partners professionally
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