- Optum (San Juan, PR)
- …as provide development for other roles you may be interested in. Required Qualifications: Registered Nurse ( RN ), Coding Certificate or Nursing Licensure, for ... Primary Responsibilities: Clinical Case Reviews -75% Perform clinical review of professional (or facility) claims...example: Puerto Rico Registered Nurse Certified Professional Coder ( CPC… more
- Elevance Health (Gilbert, MN)
- ** Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be ... background. **Preferred Skills, Qualifications, and Experiences:** + Fraud and Abuse experienced Nurse with a CPC are highly desired. For candidates working… more
- Alameda Health System (Oakland, CA)
- …using adult learning principles. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California; & Basic Life ... AHS Policies and Procedure prior to final approval by Clinical Practice Council ( CPC ). + Participates in...+ Participates in continuing education provider unit as a Nurse Planner; utilizes Board of Registered Nursing… more
- Independent Health (Buffalo, NY)
- …regulatory standards, clinical criteria, and member benefit contract. **Qualifications** + Registered Nurse ( RN ) with active, current, unrestricted NYS ... benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Clinical Reviewer will be responsible for the collection and review… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- Position Purpose: The Clinical Reviewer serves as a subject matter expert in the clinical review of claims, claim disputes, appeals and FWA special ... investigations Responsibilities: + Review of facility claim disputes including clinical ...Qualifications: + Minimum 5-7 years of experience as a clinical reviewer of facility claims in a… more
- WMCHealth (Valhalla, NY)
- …departments. + Identify pre-bill and post-bill claim edits involving any type of clinical or coding review or required modifier based on services rendered. ... Sr. Revenue Integrity Analyst (CCS/ CPC /CCA/RHIT) - On-site position Company: NorthEast Provider Solutions...appealed in a timely manner. Coordinating appeal discussions with clinical & third party payors. + Develop, Implement and… more
- Cedars-Sinai (Los Angeles, CA)
- …Los Angeles Fair Chance Initiative for Hiring. **Req ID** : 10457 **Working Title** : Registered Nurse - Clinical Documentation Specialist - 8 Hour Days ... care field preferred Foreign trained MDs will be considered License/Certifications: Registered Nurse , LVN, Occupational Therapist, Physical Therapist, Physician… more
- Cedars-Sinai (CA)
- …as a condition of continued employment. **Req ID** : 11005 **Working Title** : Registered Nurse - Lung Transplant Coordinator - Remote ON CALL **Department** : ... **Job Description** Are you ready to bring your clinical skills to a world-class facility recognized as...team, you will screen initial calls from the OPO, review and manage the EHR candidate wait list, … more
- Elevance Health (Seattle, WA)
- …and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a ... **Diagnosis Related Group Clinical Validation Auditor- RN ** **Virtual:** This role...are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical … more
- LA Care Health Plan (Los Angeles, CA)
- …of Microsoft Office suite, including Word, Excel and PowerPoint. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Payment Integrity Nurse Coder RN III Job Category: Clinical Department:...policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The… more
- Ascension Health (Austin, TX)
- …Improvement Specialists obtained prior to hire date or job transfer date. + Licensed Registered Nurse credentialed from the Texas Board of Nursing obtained prior ... the time of the offer._ **Responsibilities** Manage the daily operations of the clinical documentation area. + Manage and provide education regarding the clinical… more
- CVS Health (Harrisburg, PA)
- …Experience working with External Constituents. **Preferred Qualifications** + Unrestricted active registered nurse license. + 1+ years leadership experience. + ... for continuous learning and passion to improve population health. The successful CPC is highly collaborative, energetic, and organized in their approach to customer… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Up-to-date clinical knowledge to be able to efficiently and concurrently review medical records, understand clinical picture of the patient condition, and ... verbal and written communication skills to effectively and professionally communicate with clinical staff about review findings associated with coding and… more
- Ascension Health (Nashville, TN)
- …Improvement Specialists obtained prior to hire date or job transfer date. + Licensed Registered Nurse credentialed from the Tennessee Board of Nursing or current ... **Details** + **Department:** Clinical Documentation + **Schedule:** Full-time, Days + **Hospital:**...prior to patient's discharge. + Maintain accurate records of review activities, ensuring reports and outcomes of CDI efforts… more
- Centene Corporation (Cheyenne, WY)
- …organization or acute care hospital. **For Fidelis Care only:** One year of experience in a clinical setting or acute care hospital; RN , PA, MD, APRN, DO or MBBS ... respond to ICD-10 coding changes and its effect on inpatient claims payment. Chart review will include DRG pre-payment review , hospital readmission review … more
- OhioHealth (Columbus, OH)
- …- Registered Health Information Administrator - American Health Information Management Association, RN - Registered Nurse - Ohio Board of Nursing ... collaborate the above actions with, but not limited to, clinical departments, the Central Business Office, Health Information Management,...Description:** Certification in at least one of the following RN , CPC , CPC -H, CCS, CCS-P,… more
- UPMC (Pittsburgh, PA)
- …and Clearances:** + Certified Coding Specialist (CCS) OR Certified Professional Coder ( CPC ) OR Certified Registered Nurse Practitioner OR Doctor ... years of coding experience. In this role, you will review clinical documentation within the medical record...OR Registered Health Information Technician (RHIT) OR Registered Nurse ( RN ) + Act… more
- Fairview Health Services (St. Paul, MN)
- …experience License/Certification/Registration + One or more of the following: RHIA, RHIT, CHRI, CCS, CPC , CCS, CPC , CCS-P, RN , OR + Epic Resolute ... maintaining system applications. This role partners cross functionally with clinical and revenue cycle operational departments to achieve optimal...or more of the following: RHIA, RHIT, CHRI, CCS, CPC , CCS, CPC , CCS-P, RN ,… more
- HCA Healthcare (Overland Park, KS)
- …corrective action plans. + Collaborate and coordinate with Market Director, on the review of eligibility criteria for each clinical privilege or grouping of ... of applicable HCA Healthcare and Parallon Credentialing Processing Center ( CPC ) policies, accreditation standards and regulations associated with medical staff… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- …duties as assigned. + LICENSES AND/OR CERTIFICATIONS + Current Virginia state license as a Registered Nurse or Registered Nurse holding a valid Compact ... + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and...focus audits and reports findings. + Serves as a clinical resource for coding / denial management and customer… more
