- HCA Healthcare (Orange Park, FL)
- **Description** **Introduction** Do you want to join an organization that invests in you as a Coding Quality Audit Reviewer ? At Parallon, you come first. ... make a difference. We are looking for a dedicated Coding Quality Audit Reviewer...result in appropriate reimbursement and data integrity. You will review outcomes are communicated to the HSC team to… more
- AdventHealth (Daytona Beach, FL)
- …AHA Coding Clinic, CMS guidelines, NCCI guidance, etc. Provides outcomes of coding quality audit reviews with leadership Maintains current knowledge of ... as supporting on-going quality assurance needs for coding staff. They will review medical records...and/or outpatient coding policies, procedures, and established audit schedule; translates quality auditing results into… more
- Zelis (FL)
- …interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay ... comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines and rules, evidence based clinical criteria plan, and policy exclusions.… more
- CVS Health (FL)
- …all with heart, each and every day. **Position Summary** Responsible for performing quality inter-rater review audits of medical records coded by internal team ... mentor to provide education to internal staff based on audit findings; provides general education on ICD codes as...years recent and related experience in medical record documentation review , diagnosis coding , and/or auditing. + Experience… more
- HCA Healthcare (St. Petersburg, FL)
- …the monthly random, focus, prebill review , and Ad Hoc quality review process + Submits and reviews coding appeals as appropriate **What qualifications ... with vendor management including monitoring processes and services for improvement, coding quality , trending/analyzing data, creating and presenting education,… more
- CenterWell (Tallahassee, FL)
- …and internal business rules to respond to inquiries and issues. **Post-Visit/Offshore Coding Collaboration:** + Perform Quality Assurance on post-visit reviews. ... (Frequency and sampling methodology to be determined) + Review the encounter for potential missed opportunities. + Address...positive, collaborative mindset to foster partnership within and the Coding , Audit , and Education department, the PCO,… more
- Datavant (Tallahassee, FL)
- …provide superior quality by performing audits pertaining to risk adjustment coding efforts. The individual will be responsible for daily operations pertaining to ... closely with Management to implement benchmarks, establish acceptable thresholds, and effective quality assurance programs. **You will:** + Maintain a quality … more
- Datavant (Tallahassee, FL)
- …you will be instrumental in addressing consulting and educational needs related to coding quality , compliance assessments, external payer reviews, coding ... references for accurate DRG and APC assignment. + Review non-CC/MCC records to assess proper coding ...appropriate manager. + Prepare the final reports for the coding audit and actively participates in the… more
- Coinbase (Tallahassee, FL)
- …and fully supported. *_* *Team / Role Paragraph:* Coinbase is looking for an Internal Audit IT Senior to join the Internal Audit team focusing primarily on ... US (Remote) and will be reporting to an Internal Audit IT Senior Manager. The individual will be responsible...to maximize meetings utility, testing efficiencies and internal controls review coverage across the organization. * Serve as a… more
- LogixHealth (Dania, FL)
- …contribute to our fast-paced, collaborative environment and bring your expertise to review reimbursements and issues in Carrier Payment Audits. The ideal candidate ... skills, excellent interpersonal communication, and analytical skills. Key Responsibilities: + Review all insurance company reimbursements in all practices for all… more
- LogixHealth (Dania, FL)
- …contribute to our fast-paced, collaborative environment and will bring your expertise to review and carry out processes on all out of network claims. The ideal ... communication, and a well-rounded knowledge of insurance payers. Key Responsibilities: + Review , organize, and file IDR emails and complete responses + Monitor and… more
- Molina Healthcare (Tampa, FL)
- …on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding . **Job Summary** Utilizing clinical knowledge and experience, ... decision making pertinent to clinical experience + Documents clinical review summaries, bill audit findings and ...two years of experience in Claims Auditing, Medical Necessity Review and Coding experience + Familiar with… more
- HCA Healthcare (Ocala, FL)
- …Submit your application for the opportunity below: Revenue Integrity Charge Review Analyst Parallon **Benefits** Parallon offers a total rewards package that ... by location._** We are seeking a Revenue Integrity Charge Review Analyst for our team to ensure that we...that we continue to provide all patients with high quality , efficient care. Did you get into our industry… more
- Datavant (Tallahassee, FL)
- …and acting on undiagnosed conditions (prospective suspecting) and ensuring risk adjustment coding accuracy in near real-time (concurrent review ). You will manage ... regulations and best practices related to prospective risk capture and concurrent review . **Compliance & Quality :** + Partner with Legal, Compliance, and… more
- Elevance Health (Tampa, FL)
- …letters. + Maintains accuracy and quality standards as established by audit management. + Identifies potential documentation and coding errors by recognizing ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims. **How...clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding… more
- Elevance Health (Miami, FL)
- …or insurance sector), including a minimum of 1 year related experience in a quality audit capacity; or any combination of education and experience, which would ... **Performance Quality Analyst II** **Location:** This role requires associates...implementation audits of providers, claims processing and payment, benefit coding , member and provider inquiries, enrollment & billing transactions… more
- Humana (Miramar, FL)
- …a part of our caring community and help us put health first** The Quality Assurance, Clinical Professional 1 consults and collaborates with clinicians to ensure high ... accountability of compliance and quality . The Quality Assurance, Clinical Professional 1...all records meet federal, state, and payer-specific standards, reducing audit risk and financial exposure. The QA Auditor will… more
- AdventHealth (Altamonte Springs, FL)
- …and in collaboration with physicians, nursing and HIM coders. The CDI Quality & Compliance Team Leader strategically facilitates and obtains appropriate and ... quality physician documentation for any clinical conditions or procedures...Stewardship, and Teamwork + Completes accurate and timely record review to ensure the integrity of clarification compliance for… more
- Centene Corporation (Tallahassee, FL)
- …and responds to inquiries from state and federal regulatory agencies timely. + Quality Review all external audit deliverables for completeness and ... resource and liaison on external audit policies, communications, external audit workflow, and quality improvements initiatives. + Socializes identified risks… more
- Datavant (Tallahassee, FL)
- …preferably within an academic medical facility. + Experience with significant level of coding quality review feedback + Experience in computerized encoding ... codes from patient records, ensuring precision and adherence to documentation + Oversee and audit the work of Level 1 & 2 Coders, where applicable + Champion… more