- R1 RCM (Chicago, IL)
- …automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to draft ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and… more
- Northwell Health (Garden City, NY)
- …RN - BSN or MSN candidates with a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist- Clinical .** Validates Acute Inpatient ... standards are maintained in compliance with Federal and State regulations. 5.Applies coding rules and regulations to the validation review process. 6.Reviews… more
- Northwell Health (Garden City, NY)
- …RN - BSN or MSN candidates with a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist- Clinical . Conducts Home Health Resource ... standards are maintained in compliance with Federal and State regulations. + Applies coding rules and regulations to the validation review process. + Reviews… more
- WMCHealth (West Nyack, NY)
- HC QA- Coding Review Clinician Company: Good Samaritan Hospital Home Care City/State: West Nyack, NY Category: Home Health Department: HH Quality Assurance Union: ... Job Details: Summary: The Home Care Quality Assurance and Coding Review Clinician is responsible for assisting...responsible for assisting the PI Manager in ensuring excellent clinical outcomes and accurate HHRG Coding . This… more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The Clinical Documentation Specialist Registered Nurse facilitates improvement in the overall ... process for follow-up reviews and physician communication. + Reviews clinical issues with coding staff to assign...assessments in the medical record. + Initiates core measure review as indicated for specific clinical topics:… more
- Providence (AK)
- …Effectiveness and Data Information Set (HEDIS) program + Conduct Audits inclusive of review of outpatient medical records, hospital records, clinical lab and ... the best people, we must empower them._** **Providence Health Plan is calling a Coding Quality Auditor, HEDIS who will:** + Be responsible for conducting clinical… more
- HCA Healthcare (Richmond, VA)
- …candidates will have experience in Cath Lab (tech or charge entry), Interventional Radiology (tech, nurse or charge entry / coding ) or CV coding . + ... application for our Senior Revenue Integrity for Cath Lab and Interventional Radiology Coding Specialist opening with Parallon today and find out what it truly means… more
- University of Washington (Seattle, WA)
- …payer communications thoroughly, and communicated payer decisions in a timely manner + Review clinical denials and initiate appeals process + Conduct medical ... FINANCIAL SERVICES Department** has an outstanding opportunity for a ** CLINICAL APPEALS AND DISPUTES NURSE ** **Work Schedule**...initiatives + Assess the quality of charge capture and coding as they relate to clinical denials;… more
- Geisinger (Danville, PA)
- …methodology in which to clarify existing documentation. Acts as a liaison between the clinical and coding functions. Provides education to the medical staff and ... Job Summary The Clinical Documentation Improvement Program (CDI) is designed to...highly trained staff members to perform a concurrent inpatient review of the record. This allows the record to… more
- Geisinger (Danville, PA)
- Job Summary The Clinical Documentation Improvement Program is designed to improve the physician's documentation in the patient's medical record supporting the ... the healthcare services provided to the patient. Analyzes the clinical information, using the documentation as the primary driver....mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of… more
- Molina Healthcare (Bowling Green, KY)
- …identified by the Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review summaries, bill ... **JOB DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review...two years of experience in Claims Auditing, Medical Necessity Review and Coding experience + Familiar with… more
- Fresenius Medical Center (Breese, IL)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... Outpatient Dialysis Clinic Clinical Manager (RN) **PURPOSE AND SCOPE:** Supports FMCNA's...+ Accountable for completion of the Annual Standing Order Review and ICD coding . + Checks correspondence… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ensuring the ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well as… more
- Fresenius Medical Center (Towson, MD)
- …and auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding . + Manages clinic ... **About this role:** As a Clinical Manager with Fresenius Medical Care, you will...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Fresenius Medical Center (San Antonio, TX)
- …or federal surveys. * Participates in the completion of the FMS Administrative Clinical Review . PHYSICAL DEMANDS AND WORKING CONDITIONS: * The physical demands ... and local laws and regulations. * Ensures all FMS Clinical Quality policies and procedures are communicated to and...* Accountable for completion of the Annual Standing Order Review and ICD coding . * Checks correspondence… more
- Rising Medical Solutions (Chicago, IL)
- …our team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule ... to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in...CPC-H certification(s) strongly desired + Specialized training in hospital coding , ortho, neuro, rehab, or ER procedures + 3-5… more
- SSM Health (MO)
- …as well as the level of services rendered. The CDI Specialist assesses clinical documentation through extensive review of the medical record, interaction with ... is complete and accurate. **Principal Duties and Responsibilities** Facilitates appropriate clinical documentation to support appropriate diagnosis coding and to… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …BCBSMA's single largest account Position Summary: The RN Clinical Provider Post Service Review Manager , led by a Registered Nurse , is responsible for a team ... a member and provider call center, provider correspondence and appeals, clinical review , member correspondence and reconsiderations, enrollment, claims… more
- Trinity Health (Livonia, MI)
- …time **Shift:** **Description:** Trinity Health at Home is seeking an experienced RN Clinical Quality Review Specialist with ICD10 HCS-D certification which is ... **Trinity Health at Home is seeking an experienced RN Clinical Quality Review Specialist - REMOTE** **Position... clinical workflows, identifying errors and omissions in clinical assessments, OASIS, coding , plans of care… more
- Zelis (Morristown, NJ)
- …or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment ... Position Overview: The Nurse Reviewer is primarily responsible for conducting post-service,...skills + Highly organized with attention to detail + Clinical skills to evaluate appropriate Medical Record Coding… more