- Intermountain Health (Boston, MA)
- **Job Description:** The goal of the Clinical Documentation Specialist- Auditor is to improve the accuracy of the overall clinical picture and the ... of the complexity and severity of illness of patients through improved clinical documentation and diagnostic coding practices. Job Essentials Reviews medical records… more
- Fallon Health (Worcester, MA)
- …the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, ... health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE (Program… more
- Elevance Health (Woburn, MA)
- **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ __ This role enables associates to work virtually full-time, with the exception of required in-person training ... recover, eliminate and prevent unnecessary medical-expense spending. The **DRG CODING AUDITOR ** is responsible for auditing inpatient medical records and generating… more
- Datavant (Boston, MA)
- …educational and life experiences to realize our bold vision for healthcare. As an Auditor , HCC Risk Adjustment Coder, you will review medical records to identify and ... purposes. You will play a critical role in translating clinical documentation into precise codes that reflect the complexity...severity of a patient's health stats, **You will:** + Provide education through detailed feedback within audits. + … more
- Highmark Health (Boston, MA)
- …as needed. Attends meetings and interacts with management to resolve issues and provide advice on new programs. Provides guidance to system entities in response to ... and disease processes as it relates to the DRG/APC and other clinical data quality management factors. With technical direction and assistance from management,… more
- Humana (Boston, MA)
- …us put health first** CenterWell Senior Primary Care (PCO) is a growing provider organization that currently operates about 340+ senior focused primary care centers ... business partners to uphold ethical standards and mitigate risks. The Senior Clinical Compliance Professional will support the Director of Compliance, by ensuring… more
- Baystate Health (Springfield, MA)
- …the work is administrative. **Job Responsibilities:** **1)** Performs detailed reviews of clinical documentation for provider services using MDAudit based on ... determined intervals per provider . Validates appropriate billing and documentation that complies with...applicable use of all carrier guidelines and review of clinical documentation. **5)** Receives and screens incoming correspondence, reports,… more
- CVS Health (Boston, MA)
- …purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and ... such evidence across internal stakeholders with varying knowledge and clinical expertise in either written or verbal forms including...and vendor coding resources. + Acts as mentor to provide education to internal staff based on audit findings;… more
- Humana (Boston, MA)
- …us put health first** The Senior Inpatient Medical Coding Professional extracts clinical information from a variety of medical records and assigns appropriate ... be provided a bi-weekly payment for their internet expense. * Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet… more
- Boston University (Boston, MA)
- …BU Medical Campus. As a function of the QA role, this individual will provide assistance to clinical researchers regarding regulatory aspects to the conduct of ... or monitor/ auditor is needed. + Experience with conduct of clinical research either with pharmaceutical/device clinical trials and or observational… more