- Mass General Brigham (Somerville, MA)
- …General Brigham. Job Summary Perform DRG validation and quality audit on claims , providing coding expertise in the application of medical and reimbursement policies ... within the claim adjudication process through document review, interpretation of state...on overpayment identification. This role recovers inaccurately paid DRG claims submitted by providers, with an increasing number of… more
- Main Line Health (Broomall, PA)
- Could you be our next Compliance Auditor IPPS/OPPS with Main Line Health? Make an Impact! Compliance Auditor Inpatient Perspective Payment System/Outpatient ... Perspective Payment System (IPPS/OPPS) reviews inpatient hospital claims for proper reimbursement and handles provider disputes in a result-oriented and… more
- Optum (San Juan, PR)
- …(or facility) claims vs. medical records to determine if the claim is supported or unsupported Maintain standards for productivity and accuracy. Standards are ... Coder (CIC) Certified Outpatient Auditor (COC) Certified Professional Medical Auditor (CPMA) Certified Coding Specialist (CCS) Experience in a… more
- Clearway Pain Solutions (Annapolis, MD)
- The Billing Specialist supports the complete and timely collection of revenue for assigned groups by performing accurate coding and entry of patient and charge ... billing system. This position will track all high dollar claims from charge entry to payment and will resolve...medically necessity rules and other related functions. Assists the auditor in reviewing notes for medical necessity. Works with… more
- Elevance Health (Grand Prairie, TX)
- …claim identification, and documentation purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside of the concept ... **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ __ _This...auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all… more
- Sharp HealthCare (San Diego, CA)
- …Start Time** **Shift End Time** Other; Certified Clinical Documentation Specialist (CCDS) - Various-Employee provides certificate; Certified Health Care Compliance ... and employer business practices. **What You Will Do** The Compliance Coding Auditor is responsible for the administration of the Sharp HealthCare's (SHC's)… more
- UPMC (Pittsburgh, PA)
- **Join UPMC Corporate Compliance as an Intermediate Compliance Auditor !** Are you passionate about ensuring accuracy and compliance in healthcare documentation and ... **UPMC Corporate Compliance** is seeking a dedicated and detail-oriented **Intermediate Compliance Auditor ** to join our team! This position will be based out of… 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 ... Friday 8AM -5PM (local time) The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to ensure clinical… more
- UPMC (Pittsburgh, PA)
- **Join UPMC Corporate Finance as a Compliance Auditor , Associate!** Are you detail-oriented and passionate about ensuring compliance in healthcare? **UPMC Corporate ... Finance** is looking for a dedicated and meticulous **Compliance Auditor , Associate** to join our team. This role is crucial in maintaining the integrity of our… more
- Highmark Health (Harrisburg, PA)
- …and ensures compliance with DRG/APC structure and regulatory requirements. Performs periodic claim form reviews to check code transfer accuracy from the abstracting ... or Outpatient): Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS) + AAPC Credentials (Outpatient): Certified Professional Coder… more
- UPMC (Wexford, PA)
- …their best selves? UPMC Children's Community Pediatrics is hiring a Full-Time Compliance Auditor , Intermediate to support the office Remotely. Must live in the state ... and DRG assignment appropriateness to ensure consistency and efficiency in claims processing, data collection, and quality reporting. + Conduct audits on… more
- Commonwealth Care Alliance (Boston, MA)
- … claims management, coding rules and guidelines, and evaluating/analyzing claim outcome results for accurate industry standard coding logic and policies ... 011250 CCA- Claims Hiring for One Year Term **_This position...+ Certified Inpatient Coder (CIC) + Certified Professional Medical Auditor (CPMA) **Desired Education (nice to have):** + Masters… more
- McLaren Health Care (Shelby Township, MI)
- …audits and training of newly hired coding specialists, validating the coding specialist is accurately abstracting data into medical record systems, following coding ... and efficiency in physician documentation, code assignment, data collection, and claims processing. 3. Performs retrospective, random, and focused audits of coding… more
- Molina Healthcare (NY)
- …conducting various audits including, but not limited to; vendor, focal, audit the auditor . Confirm that documentation is clear and concise to ensure accuracy in ... auditing of critical information on claims ensuring adherence to business and system requirements of...authorizations, fee schedules, and other business requirements critical to claim accuracy. Maintain audit records, and provide counsel regarding… more
- US Pacific Fleet (CA)
- …You will be required to obtain and maintain a current ISO 9000:2008 Internal Auditor certification. + You will be required to wear personal protective equipment such ... individuals under this specific hiring authority. However, if you claim veteran's preference, you will be required to submit...see what is allowed and what is required. Any claims you make in your resume or assessment questionnaire… more
- The County of Los Angeles (Los Angeles, CA)
- CHIEF PROGRAM SPECIALIST , CEO - REAL ESTATE Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4905644) Apply CHIEF PROGRAM SPECIALIST , CEO - ... We are pursuing qualified candidates to fill Chief Program Specialist , CEO positions within the Chief Executive Office. The...final approval. + Reviews and approves all requests to auditor controller for payments to confirm the requests are… more
- Trinity Health (Albany, NY)
- …Type:** Full time **Shift:** Day Shift **Description:** Risk Adjustment Coding Specialist -St. Peter's Health Partners - Full-time - Remote **POSITION PURPOSE:** ... The Risk Adjustment Coding Specialist works in a team environment and is responsible...diagnoses assigned in the EHR by the providers to claims being submitted for their services. Using billing system… more
- St. Luke's University Health Network (Allentown, PA)
- …a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of ... coding determination made by the government or commercial payors, or their auditor representative. + Facilitate clinical chart reviews to assist with supporting… more
- University of Texas Rio Grande Valley (Harlingen, TX)
- Position Information Posting NumberSRGV8237 Working TitleCLINICAL DOCUMENTATION SPECIALIST Number of Vacancies1 LocationHarlingen, Texas DepartmentSchool of ... staff to ensure accurate physician reimbursement is achieved and claims denials are reduced by ensuring documentation integrity. *...American Academy Professional Coders ( AAPC ), Certified Coding Specialist - P ( CCS - P) from the… more
- Morrison County Government Center (Little Falls, MN)
- …received in the office; collects and compiles various information and runs reports; prepare claim forms and ensures all bills are properly coded and forwarded to the ... auditor 's office for payment. Minimum Education Required Specialized training beyond High School, but less than an associate degree. Minimum Experience Required Two… more
