- LA Care Health Plan (Los Angeles, CA)
- Payment Integrity Nurse Coder RN III Job Category: Clinical Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position Type: Full ... to support the safety net required to achieve that purpose. Job Summary The Payment Integrity Nurse Coder RN III is responsible for investigating,… more
- Elevance Health (Chicago, IL)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 ... an accommodation is granted as required by law._ **Carelon Payment Integrity ** is a proud member of...in Nursing and/or current certification as a Certified Professional Coder (AAPC or AHIMA) and minimum of 4 years… more
- Centene Corporation (Jefferson City, MO)
- …Medical Association and the Centers for Medicare and Medicaid Services. + Ensures Payment Integrity DRG Review consistently meets production standards and passes ... software systems in a managed care organization preferred. **Certifications:** RN - Registered Nurse or LPN - Licensed Practical Nurse - State Licensure and/or… more
- Molina Healthcare (Albuquerque, NM)
- …level of care, inpatient readmission, and any opportunity identified by the payment Integrity analytical team; makes decisions and recommendations pertinent to ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring timely claims … more
- Molina Healthcare (Buffalo, NY)
- …Level of Care, Inpatient Readmission, and any opportunity identified by the Payment Integrity analytical team; requires decision making pertinent to clinical ... database + Provides supporting documentation for denial and modification of payment decisions + Independently re-evaluates medical claims and associated records by… more
- UPMC (Pittsburgh, PA)
- …Auditor, Associate** to join our team. This role is crucial in maintaining the integrity of our coding and billing processes, ensuring they meet state and federal ... to hear from you! Apply now and join a team that values precision, integrity , and strategic thinking. + High School Diploma or equivalent required. + Associate's… more
- UPMC (Pittsburgh, PA)
- …will play a crucial role in upholding our standards and ensuring the highest level of integrity in our operations. Join us and be part of a team that values your ... + Knowledge of coding/classification systems appropriate for inpatient /outpatient, DRG prospective payment system or office setting E/M codes. + Experience in an… more
- AdventHealth (Maitland, FL)
- …Information Technician (RHIT), Certified Coding Specialist (CCS) or Certified Professional Coder (CPC). **Job Summary:** The Revenue Integrity (RI) Specialist ... ARE REQUIRED TO SUBMIT A RESUME WITH YOUR APPLICATION!** **Revenue Integrity Specialist - AdventHealth -** **Maitland** **Location Address:** **900 WINDERLEY PL,… more
- Health Care Service Corporation (Richardson, TX)
- …in state.** **Certified Coder preferred** **3 plus years of claim adjudication/ payment integrity ** **3 years clinical experience** **This is a Telecommute ... coding and lowest cost setting reviews for services pre and post payment utilizing medical, contractual, legislative, policy, and other information to validate… more