- Optum (San Juan, PR)
- …production environment. Primary Responsibilities: Clinical Case Reviews -75% Perform clinical review of professional (or facility) claims vs. medical records ... . Positions in this function investigates Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following… more
- Veterans Health Administration (San Diego, CA)
- …your transcript (if using education to qualify), SF-50's (current/former Federal employees), documentation to support Veterans Preference claims , or ICTAP/CTAP ... your transcript (if using education to qualify), SF-50's (current/former Federal employees), documentation to support Veterans Preference claims , or ICTAP/CTAP … more
- Veterans Health Administration (Lexington, KY)
- …your transcript (if using education to qualify), SF-50's (current/former Federal employees), documentation to support Veterans Preference claims , or ICTAP/CTAP ... your transcript (if using education to qualify), SF-50's (current/former Federal employees), documentation to support Veterans Preference claims , or ICTAP/CTAP … more
- Walmart, Inc. (Frederick, MD)
- …job provides retail pharmacies the ability to spend much deserved time providing clinical services and education to the communities they serve. We are currently ... Supports facility with reporting and paperwork to ensure productivity and pharmaceutical integrity by entering and modifying pharmaceutical data on system and forms… more
- Kyowa Kirin North America (Princeton, NJ)
- …products reflective of promotional considerations, including assessment of potential labeling claims *Serves as Promotional Review Committee (PRC) chair and as the ... of all submissions and communications with OPDP, and any supporting documentation *Provide relevant regulatory compliance training to staff and cross-functional… more
- Elevance Health (Richmond, VA)
- ** Clinical Documentation and Claims Integrity Director** **Location:** Alternate locations may be considered. This position will work a hybrid model ... Document Improvement Director** is responsible for leading encounter processing, diagnostic documentation and claims integrity across CareBridge. The ideal… more
- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment, you will be an expert in risk adjustment coding and ... documentation , working closely with physicians, IPA coders, and risk...or more years of experience in providing education to clinical and non- clinical staff, required + Understanding… more
- Commonwealth Care Alliance (Boston, MA)
- … Claims Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and necessary coding ... reports. **Essential Duties & Responsibilities:** + Develop enhanced, customized prospective claims auditing and clinical coding and reimbursement policies and… more
- Conduent (Alexandria, VA)
- …where individuality is noticed and valued every day. **Pharmacist - Claims Auditor/Reviewer (Part-Time)** **Conduent Payment Integrity Solutions** **Are you ... help improve accuracy in healthcare billing?** **About the Role** Conduent's Payment Integrity Solutions team performs detailed pharmacy claims audits on behalf… more
- University of Texas Rio Grande Valley (Harlingen, TX)
- …physician reimbursement is achieved and claims denials are reduced by ensuring documentation integrity . * Educates all members of the patient care team on ... Revenue Cycle FTE1.0 FLSAExempt Scope of Job To promote appropriate clinical documentation through collaboration with the School of Medicine clinical … more
- Trinity Health (Livonia, MI)
- …architectures, system selection, strategy, electronic health and/or financial records, clinical systems implementations and clinical process transformation as ... direction for application integration decisions with impacts across applications and clinical / business units. Assists product teams in development of design… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …Conduct comprehensive weekly/monthly/ad hoc invoice reconciliation QA audits for BCBSMA's payment integrity programs. + Audit vendor claims data and invoices ... all clinical editing inquiries, software update, QA/UAT, system updates, documentation and change requests. + Ability to work independently to resolve issues… more
- Fairview Health Services (St. Paul, MN)
- …related area Experience + 5 years' experience in coding, clinical documentation improvement (CDI) professional revenue integrity , quality, or a directly ... **Job Overview** **Fairview is looking for a Manager- Revenue Integrity to join our team.** The Manager Revenue Integrity is responsible for the leadership,… more
- Highmark Health (Harrisburg, PA)
- …satisfaction. The incumbent is responsible for the implementation of effective Payment Integrity strategies on a pre-payment and retrospective claims review ... basis. Review process includes a review of medical documentation , itemized bills, and claims data to assure appropriate level of payment and resource… more
- Hartford HealthCare (Farmington, CT)
- …codes as appropriate including charge corrections 2. Identify charging, coding, or clinical documentation issues and work with appropriate leadership and ... denials that require coding and billing expertise with some clinical knowledge that are delaying claims from...Patient Financial Services, HIM, departments, etc. regarding charging and clinical documentation issues. 3. Participate as a… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …The Clinical Reviewer serves as a subject matter expert in the clinical review of claims , claim disputes, appeals and FWA special investigations ... findings and recommendations + Comply with the CMS Program Integrity Manual and Statement of Work guidelines + Maintains...Qualifications: + Minimum 5-7 years of experience as a clinical reviewer of facility claims in a… more
- Boehringer Ingelheim (Athens, GA)
- **Description** The Senior Clinical Research Associate (SCRA) conducts in-house and external monitoring to verify that reported data collected in Clinical Lab ... raw data, and reports to support registrations and other claims related to veterinary products. The SCRA performs these...these duties for on-site and off-site (national and global) clinical studies and trials for all animal species and… more
- HCA Healthcare (Dallas, TX)
- …payor requirements as it relates to researching, analyzing, and resolving outstanding clinical denials and insurance claims . This job requires regular outreach ... individual is recognized. Submit your application for the opportunity below: Clinical Denials Coding Review SpecialistParallon. **Benefits** Parallon, offers a total… more
- Alight (NJ)
- …and accommodation claims , if within the scope of licensure and clinical expertise. + Assisting in making informed choices via patient advocacy in alignment ... calling of improving lives. **Be Alight -** act with integrity , be real and empower others. It's why we're...(https://careers.alight.com/us/en) . **About the Role** This role will provide clinical expertise and serve as a critical link between… more
- Centers for Independence (Milwaukee, WI)
- **Manager- Clinical PSN** **Job Details** **Job Location** MCFI Main Campus - Milwaukee, WI **Position Type** Full Time **Travel Percentage** Minimal; Less than 10% ... **Job Shift** Day **Description** **Job Purpose:** The clinical manager is responsible for organizing and directing the daily operations of the Pediatric Skilled… more
