- LA Care Health Plan (Los Angeles, CA)
- Medical Review Nurse Coder RN III (Payment Integrity Nurse ) Job Category: Clinical Department: Managed Care Services Location: Los Angeles, CA, US, ... to achieve that purpose. Job Summary The Payment Integrity Nurse Coder RN III is responsible for...and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and… more
- Peak Vista (Colorado Springs, CO)
- Patient Accounts Coder Summary Title:Patient Accounts Coder ID:0430-5133 Department Location:3205/3207 N. Academy, Colorado Springs, CO 80917 ... programs and education. We provide integrated health care services including medical , dental, and behavioral health through our 21 outpatient health centers.… more
- Molina Healthcare (WI)
- …DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate ... & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of… 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 ... regulations and trends in denials of services due to medical necessity or appropriateness of services. + Conducts compliance,...CERTIFICATIONS + Current Virginia state license as a Registered Nurse or Registered Nurse holding a valid… more
- CenterWell (Independence, MO)
- …team consists of doctors, advanced practice professionals, Pharm D, Care Coach Nurse , MA, Behavioral health specialist, Quality based Coder , Referral Coordinator ... care team supporting patient's physical, emotional, and social wellness. The Nurse Practitioner (VSP/PT) applies advanced education and clinical competencies to… more
- CenterWell (Decatur, GA)
- …team consists of doctors, advanced practice professionals, Pharm D, Care Coach Nurse , MA, Behavioral health specialist, Quality based Coder , Referral Coordinator ... providing a positive and welcoming environment for all. The Nurse Practitioner (NP) or Physician Assistant (PA) works in...accordance with standards of care. . Follows level of medical care and quality for patients and monitors care… more
- CenterWell (Lafayette, LA)
- …team consists of doctors, advanced practice professionals, Pharm D, Care Coach Nurse , MA, Behavioral health specialist, quality based coder , referral coordinator ... the healthcare industry as a whole. JOB SUMMARY: The Nurse Practitioner (NP) works in our team-based care environment....accordance with standards of care. + Follows level of medical care and quality for patients and monitors care… more
- Molina Healthcare (Long Beach, CA)
- …**Preferred License, Certification, Association** + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialists (CMAS) + Certified ... **JOB DESCRIPTION** **Job Summary** The **Delegation Oversight Nurse ** is responsible for ensuring that Molina Healthcare's UM delegates are compliant with all… more
- Veterans Affairs, Veterans Health Administration (Martinsburg, WV)
- …the Medical Administration Service at the Martinsburg, West Virginia VA Medical Center. The MRT ( Coder ) Clinical Documentation Improvement Specialist (CDIS) ... detailed definition of mastery level certification. OR, Clinical experience, such as Registered Nurse (RN), Medical Doctor (MD), or Doctor of Osteopathy (DO),… more
- CenterWell (Winter Haven, FL)
- …treats center patients in accordance with standards of care. + Follows level of medical care and quality for patients and monitors care using available data and ... limited to specialty referrals, hospital and SNF coordination, durable medical equipment and home health care. + Acts as...in a timely manner working with a quality- based coder to optimize coding specificity. + Follows policy and… more
- Molina Healthcare (Tacoma, WA)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/ medical reviews of previously denied ... specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long...of the following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist +… more
- Community Health Systems (Fort Wayne, IN)
- …with providers through education and the physician query process, ensuring medical records accurately reflect patient severity of illness and support continuity ... and acuity. + Adheres to corporate recommended CDI workflows and uses CDI and medical records software, such as 3M 360 Encompass and Iodine Interact, to support… more
- UNC Health Care (Chapel Hill, NC)
- …The Risk Adjustment Coordinator will be responsible for analyzing and auditing medical records retrospectively as requested by insurance companies as required by the ... of the providers and researching and responding to information requested by the payer. Review the cases in the HCC Edit WQ to determine the HCC's that need… more
- Marshfield Clinic (Marshfield, WI)
- …Accreditation._ **Minimum Required:** Bachelor's degree with an emphasis in a business or medical field, or a registered nurse degree. Completion of courses in ... Nurse license (if applicable). **Preferred/Optional:** Certified Risk Adjustment Coder awarded by American Academy of Professional Coders. **Marshfield Clinic… more
- Elevance Health (NC)
- …to ensure full accurate and appropriate diagnosis, documentation, coding and care. will review all provider visit medical encounters and apply most appropriate ... and health plan success. + Liaison to coding team. + Participate in peer review of medical documentation for completed visit notes and patient profile… more
- Hawaii Pacific Health (Honolulu, HI)
- …a not-for-profit health care network with over 70 locations statewide including medical centers, clinics, physicians and other caregivers serving Hawai'i and the ... Pacific Region with high quality, compassionate care. Its four medical centers - Kapi'olani, Pali Momi, Straub and Wilcox - specialize in innovative programs in… more
- Independent Health (Buffalo, NY)
- …**Overview** The Clinical Reviewer will be responsible for the collection and review of medical records specific to quality complaints/grievances and appeals ... document research of initial coverage determinations, and lead coordination of clinical review with appropriate internal stakeholders and Medical Director. This… more
- Guthrie (Sayre, PA)
- …through interaction with physicians, nursing staff, other patient caregivers, medical records coding staff to ensure that clinical documentation accurately ... completeness of clinical information used for measuring and reporting physician and medical center outcomes. Provides education to members of the health care team… more
- Fairview Health Services (St. Paul, MN)
- …Clinical Denials Nurse Specialist and Leadership in high-dollar claim denial review and addresses the coding components of said claims. + Reviews insurance ... expected reimbursement for services provided by the hospital. Reviews and analyzes medical records and coding guidelines to formulate coding arguments for appeals… more
- Elevance Health (Indianapolis, IN)
- …Related Group Clinical Validation Auditor** is responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs ... billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims. **How...an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in… more