- Novo Nordisk Inc. (Plainsboro, NJ)
- About the Department The Clinical , Medical and Regulatory (CMR) department at Novo Nordisk is one of the most diverse and collaborative groups within the ... find better and more innovative ways to improve their quality of life. We're changing lives for a living....NNI Finance, Global Business Services (GBS), PV & GDP Auditor (s) as well as with counterparts in Global Patient… more
- UNC Health Care (Chapel Hill, NC)
- …Association) certification - AAPC (American Academy of Professional Coders) certification - RN ( Registered Nurse ) license - LPN (Licensed Practical ... position reports to the HCS Supervisor Coding and CDI Quality and Training. This position may travel from entity...across the state to train and shadow round with Clinical Documentation Specialists. The CDS auditor provides… more
- Elevance Health (Las Vegas, NV)
- **Diagnosis Related Group Clinical Validation Auditor - RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This role enables associates to work virtually ... an accommodation is granted as required by law. The **Diagnosis Related Group Clinical Validation Auditor - RN ** is responsible for auditing inpatient medical… more
- US Tech Solutions (Newark, NJ)
- …with potential extends or Convert** **Job Description:** + The HEDIS Nurse Auditor is responsible for conducting quality audits related to state audits, ... + Support data services to identify trends and facilitate quality improvement initiatives. + Assist with clinical ...preferably in the healthcare industry. + **Active New Jersey Registered Nurse ( RN ) License required.**… more
- Molina Healthcare (Bronx, NY)
- …and/or managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... monitors clinical staff for compliance with National Committee for Quality Assurance, Centers for Medicare and Medicaid Services (CMS), and state/federal… more
- Humana (Corpus Christi, TX)
- …as needed. Requires applicable State licensure in field of study: Registered Nurse ( RN ), Licensed Masters Clinical Social Worker (LCSW), Licensed Masters ... caring community and help us put health first** The Quality Assurance, Clinical Professional 1 consults and...Medicare Conditions of Participation demand meticulous documentation. A QA Auditor will help ensure all records meet federal, state,… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Clinical Revenue Auditor -CDM Patient Financial Services-Corporate-Full-Time-Days- Hybrid.** The Clinical Revenue Auditor for the ... financial health and compliance of the organization and bridges the gap between clinical care and medical billing and reimbursement. This position will report to the… more
- Centene Corporation (New York, NY)
- …Diagnosis Related Group (DRG) and Medical Record Audit Programs for Fidelis Care. The Clinical Coding Auditor & Trainer position is primarily remote with a small ... Skills:** + Inpatient Coding Experience + At least 1 year of clinical experience in a hospital setting + RN , PA, MD, APRN, DO or MBBS license required + Strong… more
- CVS Health (Phoenix, AZ)
- …and scoring guidelines. + Participates in QM meetings. **Required Qualifications** + Active RN ( Registered Nurse ) or LPN (Licensed Practical Nurse ... heart, each and every day. **Position Summary** The **Healthcare Quality Management Auditor ** participates in the development...to)** + Completes a variety of onsite medical and clinical audits for all lines of business, including AHCCCS… more
- Henry Ford Health System (Detroit, MI)
- …Intervention (CI) or Vascular Interventional (VI) or license to practice as a registered nurse in the state of Michigan. * BLS/ACLS. Additional Information ... Proposes corrective action in charge capture problem areas. Reviews clinical documentation to ensure all records match. Participates in...a Cardiac Cath Lab Tech II or in a registered nursing role in the Cath/EP lab. PRINCIPLE DUTIES… more
- Insight Global (South Jordan, UT)
- …terminology. Expert coding knowledge (DRG & ICD-10) Registered Nurse RN (must be inpatient) WITH coding/ clinical documentation certification (2 years in ... Job Description Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100%...clinical documentation) OR IF NOT A NURSE : Degree in RHIM, RHIA, RHIT with medical coding… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and compliance functions necessary to effect accurate and complete ... focus audits and reports findings. + Serves as a clinical resource for coding / denial management and customer...AND/OR CERTIFICATIONS + Current Virginia state license as a Registered Nurse or Registered … more
- Insight Global (Plano, TX)
- …or a third-party vendor as a DRG Auditor or Clinical Documentation Specialist (CDS). Prior experience of working as a CDI/Coding auditor RN background ... DRG Auditors to join a remote healthcare organization. The DRG Revenue Integrity Auditor will perform Diagnostic Related Group (DRG) validation and quality … more
- Community Health Systems (Franklin, TN)
- **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits for both RAC and non-RAC accounts, reviewing patient records for accuracy in ... ICD-10-CM/PCS coding, DRG assignments, and supporting clinical documentation. This includes evaluating present on admission (POA)...any other relevant data to ensure coding accuracy. The auditor is also responsible for writing and defending appeal… more
- University of Washington (Seattle, WA)
- …intellectual excitement, artistic pursuits, and natural beauty. The senior healthcare auditor is responsible for the completion of internal audits within the ... clinical integrated parts of the University of Washington/UW Medicine...and conclusions drawn so other reviewers can follow the auditor 's logic and methodology. . Effectively evaluates audit results,… more
- Health Care Service Corporation (Richardson, TX)
- …document findings.** **Organizational skills and prioritization skills** **Preferred Job Qualifications:** ** Registered Nurse ( RN ) with unrestricted license ... your professional development. **Job Summary** This position is responsible for performing clinical , billing, coding and lowest cost setting reviews for services pre… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- Excellus BlueCross BlueShield (Rochester, NY)
- … clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... quality health care services. Examples may include: Utilization Management, Quality , Behavioral Health, Pharmacy, Registered Dietitian and Respiratory… more
- Molina Healthcare (IA)
- …related field or equivalent experience, OR completion of any of the following programs: + Registered Nurse ( RN ) or State Licensed Vocational Nurse (LVN), ... OR completion of any of the following programs: + Registered Nurse ( RN ) or State...**U** **C** **A** **TI** **O** **N** **:** Preferred field: Clinical Quality , Public Health or Healthcare. **PR**… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and represents non- clinical staff in discussions with Medical Directors and/or clinical consultants. + Serves as an internal auditor /peer reviewer for new ... + Current NYS RN license with a minimum of three years clinical experience; medical/surgical background preferred. + Current CPC designation or must obtain CPC… more
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