- Molina Healthcare (Dayton, OH)
- …and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities....diagnosis. Candidates with knowledge of CPT/HCPCS codes, record review, chart audit , provider disputes, appeals, and 1500… more
- Molina Healthcare (OH)
- …notes or feedback from the HEDIS audit . Makes recommendations based off of the audit and chart review. + Assists with ad hoc projects. + Participates in ... like projects and supplemental data collection. The overreader team will meet chart overread productivity standards, minimum over read standards, and 2nd overread… more
- Elevance Health (Mason, OH)
- …and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a ... **Diagnosis Related Group Clinical Validation Auditor- RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This...impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the… more
- Cleveland Clinic (Cleveland, OH)
- … Nurse ) **AND** an active State of Ohio Licensed Practical Nurse (LPN) or Registered Nurse ( RN ) licensure + **OR** a graduate of a medical college + ... codes and working DRGs, and lead process improvement initiatives based on audit findings. This position advances Cleveland Clinic's mission by enhancing the accuracy… more
- Fresenius Medical Center (Lima, OH)
- …PCT II HT are to be performed under the direct supervision of the Home Therapies registered nurse (HT RN ), in compliance with, and as permissible per state ... for patients under the direct supervision of a licensed nurse under organization policies, procedures, and training and in...processes and rapport with patients, care partners, the HT RN , direct and non-direct patient care staff, providers, and… more
- Molina Healthcare (Cleveland, OH)
- …Adjustment, is responsible for the implementation, monitoring, and oversight of all chart collection for Risk Adjustment, RADV, or Risk Adjustment-like projects, and ... other state specific audit projects and deliverables related to accurate billing and...training, onboarding for CDA team members, vendor management for chart collection vendors, Supplemental data, and chart … more