- 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
- Cynet Systems (Raleigh, NC)
- …simple to medium complexity for assigned applications and systems. Maintains data integrity and security for assigned applications and systems. Develops system ... documentation as assigned per standards. Develops communication-related education efforts...background check. Epic module certification as assigned. Epic HB/PB Claims Certification. Business Acumen. Understands the organization's strategic goals… 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
- MetroPlusHealth (New York, NY)
- …Conditions and use job aids as a guidance. Maintain accurate, comprehensive, and current clinical and non- clinical documentation in DCMS, the Care Management ... and outcomes evaluated. Job Description Address member's problems and needs: clinical , psychosocial, financial, environmental. Provide services to members of varying… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …recommends corrective actions. Training and Education: Develops curriculum and delivers clinical documentation , coding and billing education programs for ... VP, Revenue Performance Management, the Director of Billing Compliance ensures the integrity and accuracy of billing practices within the organization. This role… 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
- Veterans Health Administration (Washington, DC)
- …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
- Woundlocal (Austin, TX)
- …to service the mobile wound care practice Woundlocal . Hiring : a clinical back certified medical billing professional with extensive experience in Medicare billing ... to perform, train, and oversee verifying patient benefits, reviewing provider documentation , provide real-time feedback to the medical team, ensure timely submission… 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
- Marathon Health (Houston, MN)
- …to design and management of health center programs and policies. Administrate as a clinical team leader. Oversees other MH medical staff in clinic (ie, MA, LPN, RN). ... findings, and update patient records as appropriate. Review and audits clinical charts for quality assurance and regulatory compliances. Ensures confidentiality and… 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
- 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
- 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
