- CVS Health (Columbus, OH)
- …related to coding questions, state and federal policies, and identify potential billing errors, abuse, and fraud. + Identify opportunities for savings ... it all with heart, each and every day. The Certified Professional Coder (CPC) Manager will oversee a team of medical coders within the Special Investigations Unit… more
- Elevance Health (Mason, OH)
- …/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria and coding terminology preferred. + Knowledge ... **DRG CODING AUDITOR** **_Virtual_** **_: _** _ _ __...letter writing). + Identifies new claim types by identifying potential claims outside of the concept where additional recoveries… more
- Cleveland Clinic (Cleveland, OH)
- …of relevant clinic experience + Knowledge of medical terminology, medical records coding standards, billing practices and Care Guidelines, Medical Necessity ... most respected healthcare organizations in the world. As an EHP Case Manager , you will manage cost-effective, high-quality patient outcomes by coordinating care and… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …**Essential Job Functions** + Assists in the review of Bon Secours Mercy Health coding , billing and claims processing policies and procedures for the development ... internal and external third party claims payment peer analysis systems to detect provider- billing trends, potential fraudulent or abusive billing practices… more
- Elevance Health (Mason, OH)
- …accuracy and quality standards as established by audit management. + Identifies potential documentation and coding errors by recognizing aberrant coding ... medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and coding ...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Mason, OH)
- …as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations. + Collaborates ... Auditor II i** s responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. **How you will make an impact:** +… more
- Elevance Health (Mason, OH)
- …as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations. + Collaborates ... Auditor II** is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. **How you will make an impact:**… more
- Elevance Health (Independence, OH)
- …review and requests payments for any overpayments. + Identifies aberrant patterns of billing and detects potential abuse. + Participates in developing and/or ... which would provide an equivalent background. RN, LPN or medical coding certification strongly preferred. **Preferred Skills, Capabilities, and Experiences:** +… more
- Elevance Health (Mason, OH)
- …Investigator Senior** is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. **How you will make an ... identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to identify opportunities for fraud and abuse… more