• Medical Director - Gulf South

    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 (10/03/25)
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  • Medical Director -Payment Integrity

    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
    Humana (09/26/25)
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  • Medical Director - Claims Management

    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 (09/17/25)
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  • DRG Denials Auditor

    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
    Community Health Systems (09/09/25)
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  • Remote Coder III-IP Coder

    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
    Community Health Systems (09/18/25)
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  • Patient Services Coordinator - LPN, Home Health

    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 (09/13/25)
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  • Payment Compliance Analyst - REMOTE

    Community Health Systems (Franklin, TN)
    …to relevant departments. The PCCM Analyst collaborates with financial and clinical teams to improve revenue cycle processes and optimize payer relationships. ... and performance metrics for management review. + Collaborates with financial, clinical , and operational teams to address contract compliance issues and enhance… more
    Community Health Systems (10/03/25)
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  • Primary Care Physician

    CenterWell (Smyrna, TN)
    …medical expertise with the care team through daily huddles. + Helps Regional Medical Director and Clinic Manager 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
    CenterWell (09/06/25)
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  • CenterWell - Physician - Nashville

    CenterWell (La Vergne, 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
    CenterWell (08/09/25)
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  • Appeals Specialist I - Denials/Appeals

    Community Health Systems (Franklin, TN)
    …authorization issues related to appeals, providing necessary data for resolving inpatient/ clinical denials. + Performs other duties as assigned. + Maintains regular ... all policies and standards. **Qualifications** + HS Diploma or GED required + Associate Degree in Healthcare Administration, Business, or a related field preferred +… more
    Community Health Systems (10/01/25)
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