• Risk Adjustment Clinical Auditor/Analyst

    UPMC (Pittsburgh, PA)
    …their knowledge of anatomy, physiology, medical terminology and pathology and associated clinical processes related to the appropriateness of coding , clinical ... clinical experience. + Two years of either HCC coding , reviews or education, DRG experience, Clinical ...HCC coding , reviews or education, DRG experience, Clinical Documentation Improvement, Fraud & Abuse, Chart Auditing, or… more
    UPMC (09/30/25)
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  • Clinical Trial Contract Analyst - Medicare…

    Highmark Health (Harrisburg, PA)
    …or related field or equivalent experience + Experience as a Research Coordinator, Clinical Coordinator, Clinical Research Associate, Coding Professional or ... role such as a Research Coordinator, Clinical Coordinator, Clinical Research Associate, or Coding Professional. + Hands-on experience using a Clinical more
    Highmark Health (09/17/25)
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  • Ambulatory Coding and Doc Specialist

    Penn Medicine (Bala Cynwyd, PA)
    …team. The primary objective of this position is to improve the accuracy of coding , compliance and clinical documentation. The Certified coder (CPC or CCS-P) is ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
    Penn Medicine (08/07/25)
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  • Inpatient Medical Coding Auditor

    Humana (Harrisburg, PA)
    …of our caring community and help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and ... medical codes (eg, ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the… more
    Humana (09/24/25)
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  • Director, Prospective + Concurrent Risk Adjustment…

    Datavant (Harrisburg, PA)
    …to deliver complex healthcare technology solutions. + Solid understanding of clinical suspecting, concurrent coding workflows, risk adjustment models (eg, ... and acting on undiagnosed conditions (prospective suspecting) and ensuring risk adjustment coding accuracy in near real-time (concurrent review). You will manage a… more
    Datavant (08/08/25)
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  • HIM Clinical Documentation Specialist

    Penn Medicine (Philadelphia, PA)
    …to instruct the clinical teams in appropriate documentation as suggested by CMS coding guidelines and to ensure that the clinical chart is the true and ... of severity in care team documentation w consideration of CMS coding guidelines + Provide clinical care teams with ongoing education and training on current… more
    Penn Medicine (08/07/25)
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  • Medical Director - Spine

    CVS Health (Pittsburgh, PA)
    …Responsible for predetermination reviews ad reviews of claim determinations, providing clinical , coding , and reimbursement expertise, using multiple computer ... system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. **This is a… more
    CVS Health (08/08/25)
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  • Physician Educator HPL- Remote- Allegheny County

    UPMC (Pittsburgh, PA)
    …+ Coordinate and present education of providers/practices related to risk adjustment, coding , and clinical documentation improvement. + Assess workflow processes ... for participating providers to address issues, questions and learning needs related to coding and documentation in the medical record and the various risk adjustment… more
    UPMC (09/26/25)
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  • Oncology Data Specialist

    UPMC (Pittsburgh, PA)
    …techniques, AJCC and SEER summary staging systems, ICDO, ICD-9-CM, and/or other clinical coding systems. + Experience with hospital data systems, Microsoft ... our Registry Career Ladder. What You'll Do + Abstract and code core clinical data using appropriate classification systems. + Analyze medical records in accordance… more
    UPMC (08/13/25)
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  • Sepsis Congestive Heart Failure Performance…

    Penn State Health (Lancaster, PA)
    …and analyzes data surrounding sepsis and CHF patients to assist with documentation, coding , clinical care, and outcomes related to key leading indicators. This ... **SUMMARY OF POSITION:** Responsible to support the planning and execution of clinical quality improvement activities for the Sepsis and Congestive heart failure… more
    Penn State Health (08/23/25)
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