- Optum (San Juan, PR)
- …a production environment. Primary Responsibilities: Clinical Case Reviews -75% Perform clinical review of professional (or facility) claims vs. medical records ... Nurse (RN), Coding Certificate or Nursing Licensure, for example: Puerto Rico Registered Nurse Certified Professional Coder (CPC) + CPC A Certified Inpatient … more
- Molina Healthcare (Long Beach, CA)
- …Preferred License, Certification, Association Active and unrestricted Certified Clinical Coder Certified Medical Audit Specialists (CMAS) Certified Case ... contained in the delegation agreement. KNOWLEDGE/SKILLS/ABILITIES The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM delegates… more
- UnitedHealth Group (Minnetonka, MN)
- …the data entry and over read of non-standard supplemental data obtained from medical record review Navigate multiple documentation systems and obtain medical ... quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse - Payment Integrity Nurse Coder RN III Job Category: Clinical Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position ... to achieve that purpose. Job Summary The Payment Integrity Nurse Coder RN III is responsible for...and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and… more
- Ankura (New York, NY)
- …record documentation and understand regulatory compliance guidelines and policies + Competent in medical coding + Proficient in review of revenue cycle data ... concerns and develop project work plans + Conducts independent review of medical records + Drafts clear...in nursing from an accredited college/university + Current Registered Nurse license + Experience working for payors conducting risk… more
- Peak Vista (Colorado Springs, CO)
- Patient Accounts Coder Summary Title:Patient Accounts Coder ID:0708-5133 Department Location:3205/3207 N. Academy, Colorado Springs, CO 80917 ... programs and education. We provide integrated health care services including medical , dental, and behavioral health through our 21 outpatient health centers.… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and compliance functions necessary to effect accurate and complete ... regulations and trends in denials of services due to medical necessity or appropriateness of services. + Conducts compliance,...CERTIFICATIONS + Current Virginia state license as a Registered Nurse or Registered Nurse holding a valid… more
- CenterWell (Fort Worth, TX)
- …team consists of doctors, advanced practice professionals, Pharm D, Care Coach Nurse , MA, Behavioral health specialist, Quality based Coder , Referral Coordinator ... caring community and help us put health first** The Nurse Practitioner applies advanced education and clinical competencies to...accordance with standards of care. . Follows level of medical care and quality for patients and monitors care… more
- CenterWell (North Las Vegas, NV)
- …team consists of doctors, advanced practice professionals, Pharm D, Care Coach Nurse , MA, Behavioral health specialist, Quality based Coder , Referral Coordinator ... providing a positive and welcoming environment for all. The Nurse Practitioner (NP) works in our team-based care environment....accordance with standards of care. + Follows level of medical care and quality for patients and monitors care… more
- CenterWell (Morrow, GA)
- …team consists of doctors, advanced practice professionals, Pharm D, Care Coach Nurse , MA, Behavioral health specialist, Quality based Coder , Referral Coordinator ... and providing a positive and welcoming environment for all. **Responsibilities:** The Nurse Practitioner (NP) works in our team-based care environment. We are a… more
- CenterWell (Kansas City, KS)
- …team consists of doctors, advanced practice professionals, Pharm D, Care Coach Nurse , MA, Behavioral health specialist, Quality based Coder , Referral Coordinator ... a positive and welcoming environment for all. Responsibilities: The Nurse Practitioner (NP) works in our team-based care environment....accordance with standards of care. . Follows level of medical care and quality for patients and monitors care… more
- Molina Healthcare (Oakland, CA)
- …**Preferred License, Certification, Association** + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialists (CMAS) + Certified ... agreement. Preservice and outpatient experience. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
- CenterWell (Plant City, FL)
- …part of our caring community and help us put health first** The Nurse Practitioner applies advanced education and clinical competencies to achieve optimal patient ... outcomes. The Nurse Practitioner works on problems of diverse scope and...accordance with standards of care. + Follows level of medical care and quality for patients and monitors care… more
- Molina Healthcare (Midvale, UT)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/ medical reviews of previously denied ... specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long...of the following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist +… more
- Elevance Health (Gilbert, MN)
- …guidelines and to identify opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU**...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- Prime Healthcare (Redding, CA)
- …visit www.shastaregional.com. Responsibilities Coder /Coding Coordinator would contribute towards medical record review and analysis while utilizing the ... + Outstanding Medical , Dental, Vision coverage + Tuition reimbursement + Nurse Clinical Advancement Program (NCAP) + Many more voluntary benefit options The … more
- Trinity Health (Dubuque, IA)
- …consultant. Facilitates the overall quality, completeness, accuracy and integrity of medical record documentation through extensive record review . Through ... a place to go when you're in need of medical attention. Our Mission is based on improving the...RN, physician assistant (PA), nurse practitioner/advanced practice nurse (NP/APN), or as an inpatient coder … more
- Trinity Health (Syracuse, NY)
- …consultant. Facilitates the overall quality, completeness, accuracy and integrity of medical record documentation through extensive record review . Through ... Nursing, as an RN, physician assistant (PA), nurse practitioner/advanced practice nurse (NP/APN), or as an inpatient coder preferred. Excellent communication… more
- Marshfield Clinic (Marshfield, WI)
- …Accreditation._ **Minimum Required:** Bachelor's degree with an emphasis in a business or medical field, or a registered nurse degree. Completion of courses in ... Nurse license (if applicable). **Preferred/Optional:** Certified Risk Adjustment Coder awarded by American Academy of Professional Coders. **Marshfield Clinic… more
- OhioHealth (Columbus, OH)
- …CMS Centers for Medicare and Medicaid Service s and the American Medical Association. Communicate changes to operations leaders and department resource persons. ... for new business or capital purchases. 4. 15% Charge Audits: Audit medical documentation for accuracy and appropriateness of facility billing based on… more
