- Intermountain Health (Columbus, OH)
- …Integrity (CDI) Registered Nurses (RN) and Intermountain Physician Advisors to review complex facility encounters and assign International Classification of Diseases ... ICD-10 and Diagnosis Related Groups (DRG) codes for claims concurrently while a patient is in a hospital....reviews while patients are hospitalized. It aids in the review of quality measures including Patient Safety Indicators and… more
- Deloitte (Columbus, OH)
- …pricing studies + Implement competitive vendor search and selection initiatives + Review of health plan renewals including assisting in rate negotiation, and ... medical and pharmacy + Prepare financial projections and rate development + Review health plan performance, including reviewing policy year settlements and premium… more
- EMCOR Group (Cincinnati, OH)
- …+ Assist Fleet Manager with vehicle accidents and tracking of accidents and claims . + Assist Fleet Manager with GPS system, tracking and running location reports. ... rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of… more
- ProMedica Health System (Toledo, OH)
- …practices, including regulatory changes or updates. Reviews medical record documentation and claims data to ensure compliance with CMS and payer guidelines and ... coding/billing accuracy; summarize findings and develop plans to improve outcomes. 6. Review code change requests to determine accurate coding and/or advise coding… more
- IDEX (Mansfield, OH)
- …Manage HTS and ECCN database. Keep records of all HTS determinations and review current HTS codes for accuracy. + Maintain distributor compliance through by ... brokers and send all export and import documentation to file duty drawback claims . + Responsible for being knowledgeable on new regulations and relaying information… more
- Insight Global (Cincinnati, OH)
- …and design studies to support product claims , and ensure all product claims comply with global regulations. Candidate will review product artwork to ensure ... to consumer data focus groups to gather insights. The specialist will also conduct update meetings to ensure team...to ensure team alignment and write defensives about product claims . Preferred candidates will have the ability to assess… more
- Elevance Health (Mason, OH)
- …is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of business, and ... issues of coding and DRG assignment accuracy. Specializes in review of DRG coding via medical record and attending...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines… more
- Elevance Health (Mason, OH)
- …clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will ... make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical… more
- Banner Health (OH)
- …accurate coding based on documentation for positive outcomes. 5. Performs ongoing audits/ review of inpatient and/or outpatient medical records to assure the use of ... coding expertise to resolve issues and support appropriate reimbursement. Proficiency in claims software to address coding edits and claim denials utilizing multiple… more
- Molina Healthcare (Cincinnati, OH)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or ... of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of… more