- Optum (San Juan, PR)
- …Maintain standards for productivity and accuracy. Standards are defined by the department Provide clear and concise clinical logic to the providers when ... of the claim for further review in a production environment. Primary Responsibilities: Clinical Case Reviews -75% Perform clinical review of professional (or… more
- Zenith (Sarasota, FL)
- …leadership. This position can be filled in ANY Zenith Branch Responsible for clinical review and analysis and appropriate adjustment of billing as needed based on ... bills that have the potential for significant savings and/or reconcile outstanding provider balances to mutual satisfaction. Represents the company at the state… more
- Syneos Health Careers (Morrisville, NC)
- Description Quality and Compliance Assessor - Clinical Monitoring Excellence (Remote, 75% Travel, East & West Coast Roles) Syneos Health(R) is a leading fully ... solutions organization built to accelerate customer success. We translate unique clinical , medical affairs and commercial insights into outcomes to address modern… more
- Catalent, Inc. (Kansas City, MO)
- …home to our Oral & Specialty Drug Delivery, Biologics Analytical Services and Clinical Supply Services businesses. The site provides a range of integrated services ... solid dosage forms, from formulation development and analytical testing to clinical and commercial-scale manufacture. The Kansas City facility is a… more
- SKLD (Bloomfield Hills, MI)
- …PDPM) admissions to assure that the necessary referral records are obtained to provide comprehensive care to the resident and provide the necessary documentation ... MDS coding, Care Area, or Reimbursement concern and address appropriately with the Clinical team. *Conduct Quality of life meetings to establish OBRA schedule. Team… more
- Baystate Health (Springfield, MA)
- …health Baystate Health, western Massachusetts' only academic center and tertiary care provider has a long and proud tradition of continuous learning and improvement. ... also as a business partner to the department and clinical staff. Orients patients and families to the unit,...C Word, OA Gold, SMS, CIS, Premise, BMD, PCM Auditor , People Soft and Staples and Kronos access if… 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
- Elevance Health (Seattle, WA)
- **Diagnosis Related Group Clinical Validation Auditor -RN** **Virtual:** This role enables associates to work virtually full-time, with the exception of required ... Shift:** Monday - Friday 8AM -5PM (local time) The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records… more
- Elevance Health (Grand Prairie, TX)
- ** Clinical Provider Auditor II** **Supports the Payment Integrity line of business** **Hybrid 1:** This role requires associates to be in-office **1-2** days ... is determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Provider Auditor II** is responsible for identifying… 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
- Centene Corporation (New York, NY)
- … 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
- Centene Corporation (Salem, OR)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... findings, and vendor performance + Maintain documentation on vendor performance and provide reports to subsidiaries as required for audits and risk assessments +… more
- Humana (Montgomery, AL)
- …is a full-time, remote/work-from-home position. **Description** The Inpatient Medical Coding Auditor extracts clinical information from medical records and ... Quality Team is looking is an experienced and well-grounded medical coding auditor to quality review the inpatient hospital claims for proper reimbursement, handle… more
- Trinity Health (Albany, NY)
- … group. **SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:** Risk adjustment coding, provider auditing and clinical /education experience required. Must have 5 ... or more years' experience as a risk adjustment auditor and educator and/or clinical documentation improvement... (CPMA) required and + Education - 5+ years' provider auditing and clinical /education experience or teaching,… more
- Trinity Health (Syracuse, NY)
- … group. **SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:** Risk adjustment coding, provider auditing and clinical /education experience required. Must have 5 ... or more years' experience as a risk adjustment auditor and educator and/or clinical documentation improvement... (CPMA) required and + Education - 5+ years' provider auditing and clinical /education experience or teaching,… more
- Elara Caring (Broken Arrow, OK)
- …the Right Place. **Job Description:** FULL TIME MONDAY - FRIDAY STARTING AT $62,400/YEAR ** Clinical Quality Auditor ** The Clinical Quality Auditor ... like home, and that's why our teams continue to provide high-quality care to more than 60,000 patients each...have countless ways to make a difference as a Clinical Quality Auditor , by keeping a team… more
- Virtua Health (Mount Laurel, NJ)
- …Conducts meetings to discuss outcomes, reviews reports, works with physicians to provide appropriate clinical documentation, to ensure compliant assignment of ... practitioners equipped with the latest technologies, treatments, and techniques to provide exceptional care close to home. A Magnet-recognized health system ranked… more
- Aveanna Healthcare (Homestead, FL)
- …with Investigators, multi-disciplinary research team and Client Company representatives (eg, Clinical Research Associate (CRA), auditor ) Provide support ... Clinical Research Nurse - Illingworth (RN) ApplyRefer a...Nursing Salary: $50.00 - $55.00 per hour Position Details CLINICAL RESEARCH NURSE - Illingworth (RN) Job Overview: Aveanna… more
- Planned Parenthood of Central and Western NY (Rochester, NY)
- Billing Auditor for Shared Services Fully Remote * Rochester, Buffalo, or Syracuse, NY * Revenue Cycle Description Billing Auditor for Shared ServicesBuffalo, ... of PPCWNY's mission and the collaboration with Shared Services, the Billing Auditor evaluates Revenue Cycle outcomes to identify and recommend opportunities for… more
- Veterans Affairs, Veterans Health Administration (Murfreesboro, TN)
- …is located in the Health Information Management (HIM) section in the Clinical Operations/Health Informatics Service at the Tennessee Valley Healthcare System (TVHS). ... that categorizes all VA patients into specific classes representing their clinical conditions and resource needs. Responsibilities Auditors perform audits of… more
