- Elevance Health (Latham, NY)
- …make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims. **How...audit activities. + Draws on advanced ICD-10 coding expertise, mastery of clinical guidelines, and… more
- Elevance Health (Latham, NY)
- Nurse Audit Lead - Carelon Payment Integrity **Location:** The ideal candidate will live within 50 miles of one of our pulse point locations and will work on a ... is determined to recover, eliminate, and prevent unnecessary medical-expense spending. The ** Nurse Audit Lead** is responsible for leading a team of clinicians… more
- CDPHP (Albany, NY)
- …Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations ... these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and grievance… more