- Elevance Health (Indianapolis, IN)
- ** Clinical Provider Auditor I - Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering ... an accommodation is granted as required by law._ **Carelon Payment Integrity** is a proud member of the Elevance...to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Provider Auditor I** will… more
- Elevance Health (MD)
- ** Clinical Provider Auditor II** **Supports the Payment Integrity line of business** **Location: Must be located in Maryland.** This field-based role ... an accommodation is granted as required by law._ Carelon Payment Integrity is a proud member of the Elevance...to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Provider Auditor II** is… more
- Elevance Health (Norfolk, VA)
- ** Clinical Provider Auditor II**...an accommodation is granted as required by law. Carelon Payment Integrity is a proud member of the Elevance ... Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent...to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Provider Auditor II i**… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …communities that we serve through our Healthsource blog: https://healthsource.premera.com/ . As a ** Payment Integrity Auditor I** , you will support the overall ... objectives of the Payment Integrity office. This role is responsible for conducting...and policy non-compliance. Audits include reviewing medical records, applying clinical and coding knowledge, analyzing provider billing… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Clinical Revenue Auditor -CDM Patient Financial Services-Corporate-Full-Time-Days-Option to work remote or hybrid.** The Clinical ... to patients are accurately documented, coded, and submitted for payment . This position plays a key role in ensuring...compliance of the organization and bridges the gap between clinical care and medical billing and reimbursement. This position… more
- Elevance Health (Los Angeles, CA)
- …of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and ... **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG...or any combination of education and experience, which would provide an equivalent background. **Preferred Skills, Capabilities and Experiences:**… more
- Humana (Boise, ID)
- …our caring community and help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and ... a bi-weekly payment for their internet expense. * Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Plans' provider agreements and the National Healthcare guidelines. The Professional Auditor helps improve clinical outcomes and quality of care, to reduce ... true colors to blue. About the Role: The Professional Auditor is responsible for post-pay review to verify the...post-pay review to verify the accuracy of claims reimbursement, clinical significance, coding, and billing in accordance with the… more
- Elevance Health (Chicago, IL)
- …quality assurance environment preferred. + Broad knowledge of medical claims billing/ payment systems provider billing guidelines, payer reimbursement policies, ... **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ __ This...an accommodation is granted as required by law._ Carelon Payment Integrity is a proud member of the Elevance… more
- HCA Healthcare (Caldwell, ID)
- …recognized. Submit your application for the opportunity below: Inpatient Coding Quality Auditor Parallon. **This is a fully work from home position.** **This ... by location._** We are seeking an Inpatient Coding Quality Auditor for our team to ensure that we continue...for our team to ensure that we continue to provide all patients with high quality, efficient care. Did… more
- Rush University Medical Center (Chicago, IL)
- …on the circumstances of each case. **Summary:** The Billing Coding Auditor uses advanced knowledge of billing, coding, auditing, documentation requirements, and ... charge capture to solve complex charging scenarios, provide education and assistance to operational departments, support fellow team members, and develop… more
- Insight Global (South Jordan, UT)
- …MS-DRG, AP-DRG, and APR-DRG with a broad knowledge of medical claims billing/ payment systems provider billing guidelines, payer reimbursement policies, medical ... Job Description Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100%...should have an extensive background in either facility-based nursing, clinical documentation, and/or inpatient coding and has a high… more
- UCLA Health (Los Angeles, CA)
- Description Take on an important role within a world-class health organization. Provide specialized expertise that enables the efficient operation of a complex ... this and more at UCLA Health. The Claims Quality Auditor will be responsible for the daily audit of...policies and procedures. You will: + Research over and under- payment inquiries/appeals + Compile and maintain statistical data consistent… more
- Highmark Health (Nashville, TN)
- …as needed. Attends meetings and interacts with management to resolve issues and provide advice on new programs. Provides guidance to system entities in response to ... and disease processes as it relates to the DRG/APC and other clinical data quality management factors. With technical direction and assistance from management,… more
- UCLA Health (Los Angeles, CA)
- …degree and/or equivalent experience * Five or more years of medical claims payment experience in Medicare Advantage or combination of equivalent years of education, ... HCPCS, ICD-10, ASA, Revenue Codes * Experience researching and resolving provider dispute resolutions, adjustments, appeals, and reopen guidelines * Understanding of… more
- Commonwealth Care Alliance (Boston, MA)
- …on edits implemented. + Utilize data to examine large claims data sets to provide analysis and reports on existing provider billing patterns as compared to ... Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and necessary coding configuration requirements… more
- Trinity Health (Livonia, MI)
- …group practice revenue cycle front-end functions such as patient registration and provider payment enrollment and back-end functions that may impact charge ... including but not limited to, appending modifiers, and checking clinical documentation. Provides feedback to intra-departmental Revenue Integrity colleagues… more
- Rush University Medical Center (Chicago, IL)
- …each case. **Summary:** As a key role in the Revenue Integrity team, the Auditor & Educator is responsible for conducting reviews of EMR documentation of patient ... accuracy and documentation adequacy. The professional will work collaboratively with clinical providers to improve revenue cycle integrity while seeking and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …drivers. Essential Accountabilities: Level I + Handles physical health member clinical management programs. + Maintains knowledge of current Case Management Society ... or external referral sources. Applies case management criteria and professional clinical judgment to determine a member's appropriateness for case management… more
- Banner Health (Casper, WY)
- …Ensure all documentation is accurate, secure, and compliant. Collaborate with clinical teams to optimize patient flow and satisfaction. Use multi-system technology ... to accurately complete daily work list. This may include working with the ordering provider and/or payer to fully clear a patient's account prior to the date of… more