- Centene Corporation (Atlanta, GA)
- …and requires an clinical license. 3+ years of nursing or quality improvement experience. **Licenses/Certifications:** Current state's clinical license ... processes to measure member outcomes. Assess provider performance and quality of care through clinical case reviews....and delivered timely + Perform other performance and process improvement activities + Performs other duties as assigned +… more
- UPMC (Pittsburgh, PA)
- UPMC Health Plan has an exciting opportunity for a Clinical Auditor /Analyst Intermediate! The Clinical Auditor /Analyst Intermediate is an integral part ... establishes and revises better best practice within the department. The Clinical Auditor /Analyst Intermediate creates, maintains and analyzes auditing reports… 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
- Elevance Health (Chicago, IL)
- …state(s). + Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement , and a minimum of ... **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG...and Hospital-Acquired Conditions (HACs). + Suggests and develops high quality , high value, concept and or process improvement… more
- Elevance Health (Boston, MA)
- …reporting and trending analysis. + Provides feedback on processing errors; identifies quality improvement opportunities and initiates basic requests related to ... all the above, plus: Independently interprets Medical Policy and Clinical Guidelines. + **Claims Auditor Senior** -...a minimum of 1 year related experience in a quality audit capacity (preferably in healthcare or insurance sector);… more
- Integra LifeSciences (Princeton, NJ)
- …the audited sites such as follow-up or re-audits and participate in any continuous improvement or quality initiatives as a representative of Global quality ... engineering and design, statistical analysis, process validation, regulatory compliance, clinical trials, computer systems validation, quality systems and/or… more
- Kelly Services (Lancaster, SC)
- …CFR Parts 210, 211, 507, and 111 (or equivalent standards). + Certification as a Quality Auditor (eg, ASQ CQA) is preferred. + Strong computer skills, including ... ** Quality Assurance Auditor ** **Location: Lancaster, South...potential areas of internal non-compliance, and contribute to process improvement or policy development. + Assist in preparation for… more
- Catalent Pharma Solutions (Greenville, NC)
- ** Quality Assurance Auditor ** The Quality Assurance Auditor will provide key quality support and leadership to development, operations, and ... projects. **Position Summary** This position is 100% on-site at the Greenville site. The Quality Assurance Auditor will lead in promotion of a culture of… more
- Bristol Myers Squibb (Indianapolis, IN)
- …application should be directed to Chat with Ripley. R1594472 : Senior Quality Auditor **Company:** Bristol-Myers Squibb **Req Number:** R1594472 **Updated:** ... GCP), internal procedures, and industry standards. This role supports the continuous improvement of RayzeBio's Quality Management System and ensures readiness… more
- Humana (Columbus, OH)
- …entry regarding claim/encounter information + Support and participate in process and quality improvement initiatives **What Humana Offers** We are fortunate to ... our caring community and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct… more
- US Tech Solutions (Newark, NJ)
- …providers. + Support data services to identify trends and facilitate quality improvement initiatives. + Assist with clinical studies, quality projects, ... extends or Convert** **Job Description:** + The HEDIS Nurse Auditor is responsible for conducting quality audits related to state audits, HEDIS measures, and … more
- Sharp HealthCare (San Diego, CA)
- …Hospital/Facility (CIC), or Certified Professional Coder (CPC) certification.Certified Clinical Documentation Improvement Practitioner or Specialist (CDIP ... matters and other general Compliance reimbursement inquiries.Will continuously evaluate the quality of clinical documentation and monitor the appropriateness of… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …coding and compliance with regulatory requirements. This role ensures continuous quality improvement in coding practices while maintaining compliance with ... **42910BR** **Extended Job Title:** Medical Coding Auditor **Org Level 1:** Texas Tech Unv Hlth...refining audit tools, policies, and procedures to support continuous improvement + Monitor and track corrective actions post-audit, ensuring… more
- Community Health Systems (Franklin, TN)
- …years Inpatient acute care hospital coding audit experience preferred + 1-2 years Clinical Documentation Improvement or other clinical experience preferred ... **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits for...Registered Health Information Administrator required or + CDIP - Clinical Documentation Improvement Professional required or +… more
- Humana (Madison, WI)
- …part of our caring community and help us put health first** The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record ... experience + Prospective payment methodologies, DRG auditing experience + Clinical documentation improvement knowledge (CDE, CDEI certification) **Additional… more
- Northwell Health (Lake Success, NY)
- …the organization remains at the forefront of regulatory adherence, risk mitigation, and quality improvement . Ready to make a difference in healthcare compliance ... **Req Number** 174853 Lead Compliance Auditor - Heavy Anesthesia & Healthcare Expertise Needed....billing practices. + Develop and deliver targeted training for clinical staff on anesthesia coding, documentation, and regulatory requirements.… more
- Cedars-Sinai (Los Angeles, CA)
- …the National Research Corporation's Consumer Choice Award 19 times for providing the highest- quality medical care in Los Angeles. We also were awarded the Advisory ... the general direction of the Manger or Associate Director, the Revenue Auditor Service Line performs audits of medical records against submitted professional… more
- Elevance Health (Chicago, IL)
- …as re-admissions, Inpatient to Outpatient, and HACs. + Suggests and develops high quality , high value concept and or process improvement and efficiency ... **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ __ This...Clinical Validation Audit setting or hospital coding or quality assurance environment preferred. + Broad knowledge of medical… more
- Elevance Health (Chicago, IL)
- …Preventable Adverse Events (PAEs) or Never Events. + Suggests and develops high quality , high value concept and or process improvement and efficiency ... **DRG Coding Auditor Principal** **_Virtual: _** _ _ This role...Clinical Validation Audit setting or hospital coding or quality assurance environment preferred. + Broad, deep and niche… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Revenue Integrity Auditor Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the region's top-performing healthcare ... and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million...seek out better ways to do our job, set improvement goals and standards striving to meet or exceed… more