- Premera Blue Cross (Mountlake Terrace, WA)
- …By leveraging a deep understanding of ICD-10 and other coding standards, the auditor reviews and researches provider diagnostic coding issues, performs detailed ... serve through our Healthsource blog: https://healthsource.premera.com/ . The **Medical Coding Auditor ** plays a crucial role in ensuring the accuracy and compliance… more
- Integra LifeSciences (Princeton, NJ)
- …status of the facilities audited. This role as a Subject Matter Expert (SME), will provide internal consultancy on area(s) of expertise to the audit team as well as ... initiatives as a representative of Global quality organization. + Provide review and support to individuals, working groups or...GLP or GCP (as applicable) audits as a Lead Auditor for multi-national manufacturing companies in the medical devices… more
- Lyric (Newtown Square, PA)
- …as a medical coder, medical claims adjuster, medical claims processor, chart reviewer/ auditor , denial management analyst, clinical editing analyst, or payment or ... The team member serves as subject matter expert on clinical content and editing topics. This role is vital...team to expedite result reviews for edit profitability + Provide medical coding and billing subject matter expertise on… more
- Stanford Health Care (Palo Alto, CA)
- …Education (GME) affiliation agreements + Physician outreach and other academic/ clinical support contracts + Coordinate with internal department, affiliated entities, ... issues in clear, concise narratives to support strategic decision-making. + Provide analytical and subject matter support to broader strategic and financial… more
- Olympus Corporation of the Americas (Center Valley, PA)
- …safety, quality and compliance for the design, manufacture, and service of clinical and research products. Primary Responsibilities: The Global Vice President QARA ... and manage supplier qualification activities and monitor suppliers' performance and provide recommendations. + Coordinates and leads audit activities with all global… more
- UPMC (Pittsburgh, PA)
- …modification to company policies and procedures. + Perform audit peer reviews for Clinical Auditor /Analysts. + Provide new-hire training to Clinical ... UPMC Health Plan has an exciting opportunity for a Clinical Auditor /Analyst Intermediate! The Clinical ... care, documentation, and health plan business rules. + Provide a clinical opinion for special projects… more
- Baylor Scott & White Health (Dallas, TX)
- …vary based on position type and/or level **Job Summary** In this job, as a Clinical Auditor RN, you'll perform charge capture accuracy audits by reviewing and ... and provide counsel to Revenue Integrity team members and/or clinical departments/functions. + Documents and tracks audit findings for account corrections and… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Clinical Revenue Auditor -CDM Patient Financial Services-Corporate-Full-Time-Days- Hybrid.** The Clinical Revenue Auditor for the ... financial health and compliance of the organization and bridges the gap between clinical care and medical billing and reimbursement. This position will report to the… more
- Elevance Health (Chicago, IL)
- **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This role enables associates to work virtually ... accommodation is granted as required by law. The **Diagnosis Related Group Clinical Validation Auditor -RN** is responsible for auditing inpatient medical records… more
- Elevance Health (Grand Prairie, TX)
- ** Clinical Provider Auditor I** **Location** : We prefer any of the following cities/States: Woodland Hills, CA; Denver, CO; Miami, FL; Tampa, FL; Atlanta, ... an accommodation is granted as required by law. The ** Clinical Provider Auditor I** is...or any combination of education and experience, which would provide an equivalent background. Must achieve coding certification (CPC,… more
- St Croix Hospice (Mendota Heights, MN)
- …an extraordinary team of caregivers, then come work where you matter. Compliance Auditor ( Clinical ) Position Overview The Compliance Auditor is responsible ... and working cross-functionally to implement corrective actions. The Compliance Auditor will lead risk assessments, internal audits and compliance investigations… more
- Cleveland Clinic (Cleveland, OH)
- …with one of the most respected healthcare organizations in the world. As a Clinical Senior Internal Auditor , you will conduct audit procedures for assigned ... the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top… more
- UNC Health Care (Chapel Hill, NC)
- …from entity to entity across the state to train and shadow round with Clinical Documentation Specialists. The CDS auditor provides elbow to elbow support during ... we serve. Summary: This positon trains and audits Inpatient and Outpatient Clinical Documentation Specialists (CDS) across all HCS entities that are owned or… more
- CGI Technologies and Solutions, Inc. (Dallas, TX)
- **Remote Senior Inpatient Auditor - MS-DRG & Clinical Validation** **Category:** Analytics and Emerging Digital Technologies **Main location:** United States, ... **Employment Type:** Full Time **Position Description:** CGI is seeking a high-caliber MS-DRG Auditor to join our Healthcare Compliance Team. In this role, you will… more
- Centene Corporation (Atlanta, GA)
- … documentation, and modify business processes to measure member outcomes. Assess provider performance and quality of care through clinical case reviews. ... + Lead clinical audits for provider medical records both remotely via electronic medical records...quality services + Lead case reviews to assess the clinical performance provided in the provider network,… more
- Insight Global (Plano, TX)
- …years working in an acute care setting or a third-party vendor as a DRG Auditor or Clinical Documentation Specialist (CDS). -CCS Certification RN or BSN RHIT or ... DRG Auditors to join a remote healthcare organization. The DRG Revenue Integrity Auditor will perform Diagnostic Related Group (DRG) validation and quality audits on… more
- Humana (Columbus, OH)
- …our caring community and help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and ... codes (eg, ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis… more
- Elevance Health (Richmond, VA)
- **Nurse Auditor Senior - Payment Integrity Complex and Clinical Audit** **Location:** This role enables associates to work virtually full-time, with the ... providers through prepayment claims review, post payment auditing, and provider record review. **How you will make an impact:**...AS in nursing and minimum of 4 years of clinical nursing experience; or any combination of education and… more
- Humana (Jackson, MS)
- …our caring community and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct ... are met (eg, ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor 's work assignments are varied and frequently require interpretation...to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by… more
- Adecco US, Inc. (Bradenton, FL)
- …education and training to healthcare providers. **Responsibilities of the Coding Auditor and Educator:** . Facilitates optimal clinical documentation performance ... Healthcare & Life Sciences is looking for a **Coding Auditor and Educator** for our client in **Bradenton, FL!**...charts in the EHR and identifies potential gaps in provider documentation . Applies clinical knowledge and… more
