- Humana (Nashville, TN)
- …these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical … more
- Humana (Nashville, TN)
- …may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, dispute, grievance, and appeals processes, ... Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care received by… more
- Humana (Nashville, TN)
- …discussions with an external provider. Some roles include an overview of coding practices and clinical documentation, dispute/grievance and appeals processes, ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- Community Health Systems (Franklin, TN)
- …RAC and non-RAC accounts, reviewing patient records for accuracy in ICD-10-CM/PCS coding , DRG assignments, and supporting clinical documentation. This includes ... denial and appeal status. + Consults with Coordinator and/or Director , Coding Denials and Appeals during any...+ HS Diploma or GED required + Other Medical Coding Program preferred + Associate Degree Health… more
- Datavant (Nashville, TN)
- …will be instrumental in addressing consulting and educational needs related to coding quality, compliance assessments, external payer reviews, coding education, ... HCC is a plus. **You Will:** + Conduct inpatient coding audits on medical records, utilizing ICD-10-CM, CPT, and...results for review by the facility or CCS HIM director . + Review disagreements on APC/DRG changes with the… more
- Community Health Systems (Franklin, TN)
- …to providers for documentation clarification to include diagnosis clarification based on clinical indicators and coding specificity requirements. + Consults the ... and where your work is purposeful and fulfilling. At CHS, our coding team recognizes your individual talents, encourages professional development, and provides… more
- CenterWell (Knoxville, TN)
- …calls from the field staff and assisting with weekly case conferences. Refers clinical questions to Branch Director as necessary. + Maintains the client ... productivity / geographic issues and forwards schedule to Branch Director for approval prior to distribution to staff. +...internal transfer of patients between branch offices. + If clinical , receives lab reports and assesses for normality, fax… more
- CenterWell (Old Hickory, TN)
- …expertise with the care team through daily huddles. + Helps Regional Medical Director and Center Administrator in setting a tone of cooperation in practice by ... manner working with a quality- based coder to optimize coding specificity. + Follows policy and protocol defined by... specificity. + Follows policy and protocol defined by Clinical Leadership. + Meets with RMD about quality of… more