- 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
- Health eCareers (Rogers, MN)
- …Qualifications: Education: RN , BSN, RHIA, RHIT, CCS, CPC , CICExperience:3-5 years CDI experienceCertification/Registration: CCDS (Certified Clinical ... with our mission, values, and Mercy Service Standards.Qualifications:Minimum Required Qualifications: Education: RN , BSN, RHIA, RHIT, CCS, CPC , CIC, CCDS, or… 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
- 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
- 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
- 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 ... in Nursing Experience Required: At least 8 years of clinical RN experience. At least 3 years...Office suite, including Word, Excel and PowerPoint. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… 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
- Ankura (New York, NY)
- …+ Bachelor's degree in nursing from an accredited college/university + Current Registered Nurse license + Experience working for payors conducting risk ... and compliance matters during due diligence. We serve as the Independent Review Organization and Quality Monitorship for many clients, and our work product… 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
- Ascension Health (Zionsville, IN)
- …Documentation ImprovementSpecialists obtained prior to hire date or job transfer date. + Registered Nurse credentialed from the Indiana Board of Nursing obtained ... **Details** + **Department:** Health Information Management + Clinical Documentation Integrity, Must have previous or current...with previous inpatient CDI experience is required. An Indiana RN License is required at the time of hire.… 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
- St. Mary's Healthcare (Amsterdam, NY)
- …Improvement Specialists obtained prior to hire date or job transfer date. * Registered Nurse credentialed from the New York Board of Nursing obtained ... Ensures the working DRG and other information are entered in the Clinical Documentation Improvement database. * Initiates and maintains extensive interactions with… 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
