- UNC Health Care (Chapel Hill, NC)
- …Association) certification - AAPC (American Academy of Professional Coders) certification - RN ( Registered Nurse ) license - LPN (Licensed Practical ... position reports to the HCS Supervisor Coding and CDI Quality and Training. This position may travel from entity...across the state to train and shadow round with Clinical Documentation Specialists. The CDS auditor provides… more
- Humana (Corpus Christi, TX)
- …of our caring community and help us put health first** The Home Health Quality Auditor ensures clinical documentation meets CMS regulations, OASIS accuracy, ... accuracy, and completeness, helping reduce audit risk and billing delays. The auditor monitors QA metrics, identifies trends, and collaborates with leadership to… more
- Elevance Health (Washington, DC)
- **Diagnosis Related Group Clinical Validation Auditor - RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This role enables associates to work virtually ... and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a… more
- US Tech Solutions (Newark, NJ)
- …with potential extends or Convert** **Job Description:** + The HEDIS Nurse Auditor is responsible for conducting quality audits related to state audits, ... + Support data services to identify trends and facilitate quality improvement initiatives. + Assist with clinical ...preferably in the healthcare industry. + **Active New Jersey Registered Nurse ( RN ) License required.**… 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
- CVS Health (Phoenix, AZ)
- …and scoring guidelines. + Participates in QM meetings. **Required Qualifications** + Active RN ( Registered Nurse ) or LPN (Licensed Practical Nurse ... heart, each and every day. **Position Summary** The **Healthcare Quality Management Auditor ** participates in the development...to)** + Completes a variety of onsite medical and clinical audits for all lines of business, including AHCCCS… more
- Insight Global (South Jordan, UT)
- …terminology. Expert coding knowledge (DRG & ICD-10) Registered Nurse RN (must be inpatient) WITH coding/ clinical documentation certification (2 years in ... Job Description Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100%...clinical documentation) OR IF NOT A NURSE : Degree in RHIM, RHIA, RHIT with medical coding… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits for both RAC and non-RAC accounts, reviewing patient records for accuracy in ... ICD-10-CM/PCS coding, DRG assignments, and supporting clinical documentation. This includes evaluating present on admission (POA)...any other relevant data to ensure coding accuracy. The auditor is also responsible for writing and defending appeal… 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 ... focus audits and reports findings. + Serves as a clinical resource for coding / denial management and customer...AND/OR CERTIFICATIONS + Current Virginia state license as a Registered Nurse or Registered … more
- Insight Global (Plano, TX)
- …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 RHIA ... DRG Auditors to join a remote healthcare organization. The DRG Revenue Integrity Auditor will perform Diagnostic Related Group (DRG) validation and quality … more
- Covenant Health Inc. (Knoxville, TN)
- …study or current clinical license/registration in the State of Tennessee as RN with equivalent coding experience. Apply/Share Job Title REV INTEGRITY AUDITOR ... Overview Revenue Integrity Auditor Full Time, 80 Hours Per Pay Period,...and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million… more
- University of Washington (Seattle, WA)
- …intellectual excitement, artistic pursuits, and natural beauty. The senior healthcare auditor is responsible for the completion of internal audits within the ... clinical integrated parts of the University of Washington/UW Medicine...and conclusions drawn so other reviewers can follow the auditor 's logic and methodology. . Effectively evaluates audit results,… more
- Centene Corporation (Jefferson City, MO)
- … Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), Licensed Professional Counselor (LPC), Registered Nurse ( RN ), or Licensed Practical Nurse ... the auditing of corporate, health plan, and specialty company staff related to clinical systems entry and/or processes + Develop and maintain the audit process and… more
- Banner Health (AZ)
- …and High Volume Specialists (HVS). This position is also responsible for assisting the QM RN with the investigation and research of quality of care concerns that ... **Department Name:** Banner Staffing Services-AZ **Work Shift:** Day **Job Category:** Risk, Quality and Safety **Estimated Pay Range:** $26.40 - $44.00 / hour,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- … clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... quality health care services. Examples may include: Utilization Management, Quality , Behavioral Health, Pharmacy, Registered Dietitian and Respiratory… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and represents non- clinical staff in discussions with Medical Directors and/or clinical consultants. + Serves as an internal auditor /peer reviewer for new ... + Current NYS RN license with a minimum of three years clinical experience; medical/surgical background preferred. + Current CPC designation or must obtain CPC… more
- NCH (Naples, FL)
- …Integrity Specialist for educational opportunities/outcomes. * Collaborates with CDI liaison/ quality auditor when educational needs are identified from ... together. Visit nchjobs.org to learn more. JOB SUMMARY The Quality Improvement Clinical Documentation Integrity Specialist (QI-CDIS)...Degree required; Bachelor's Degree preferred. * Licensed as a Registered Nurse in the state of Florida.… more
- Catholic Health Initiatives (Little Rock, AR)
- …zones, and up to 25-50% professional travel may be involved. + Supports quality , clinical practice, safety, risk coding, compliance, patient experience and ... functions within the Value Hub (Clinically Integrated Networks/CINs). + Facilitates quality and patient experience performance across the SE Region Value Hub… more
- Baystate Health (Springfield, MA)
- …**10)** Observes cardiac monitors. Identifies and reports irregular rhythms to a registered nurse for interpretation and intervention. Records and processes EKG ... communication with NEOPO and related paperwork in conjunction with RN . Screen calls for the clinical team...clinical team inquiry. In coordination with the charge nurse , prepare staffing assignments for the next shift. Place… more