- CVS Health (Atlanta, GA)
- …purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and ... internal policies and procedures. + Proven ability to support coding judgment and decisions using industry standard evidence and tools. + Proficient in abstraction… more
- Datavant (Atlanta, GA)
- …and reimbursement purposes. You will play a critical role in translating clinical documentation into precise codes that reflect the complexity and severity of ... to the table:** + Minimum 3 years of HCC coding experience + Minimum 2 years of HCC Auditing...CPC-H, COC, CIC or CRC). + Proficient in ICD-10 coding . + Experienced in HCC coding across… more
- Emory Healthcare/Emory University (Duluth, GA)
- …cycle activities of the Hospital, including patient registration, precertification, coding , clinical documentation integrity, billing, cash collections, and ... denials. **FINANCIAL REPORTING AND ANALYSIS:** + Conduct thorough financial analysis to support decision-making and identify opportunities for improvement in partnership with Financial Planning and Analytics team. + Prepare and present accurate and timely… more
- Humana (Atlanta, GA)
- …these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials,… more
- Humana (Atlanta, GA)
- …these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials,… more
- Elevance Health (Atlanta, GA)
- ** Clinical Provider Auditor II** **Hybrid 1:** This role requires associates to be in-office **1 - 2** days per week, fostering collaboration and connectivity, while ... determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Provider Auditor II i** s responsible for identifying issues and/or… more
- Highmark Health (Atlanta, GA)
- …and leads the design, development, execution, dissemination and interpretation of clinical and population health analyses, metrics and reports using clinical ... monitor actionable opportunities for improving health and healthcare outcomes and clinical quality and costs of care, efficiently and effectively managing projects… more
- CVS Health (Atlanta, GA)
- …BCBA or BCBA-D credential + Experience with and knowledge of CPT and HCPCS coding guidelines and principles + Experience using clinical expertise in reviewing ... is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. Under the direction… more
- Elevance Health (Atlanta, GA)
- ** Clinical Provider Auditor II** **Supports the Payment Integrity line of business** **Virtual:** This role enables associates to work virtually full-time, with the ... determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Provider Auditor II** is responsible for identifying issues and/or… more
- Molina Healthcare (GA)
- …home office with internet connectivity of high speed required **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical ... decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical reviews of… more