- Catholic Health Services (Melville, NY)
- …guidance and communication on correct charge capture and billing processes to clinical department and facilities. Perform periodic reviews and assessments of charge ... for new services and/or new/updated technology. Works with Coding and clinical departments to identify/resolve errors based on ICD/CPT Coding Guidelines and… more
- Molina Healthcare (Albany, NY)
- …+ Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and...Long-Term Services & Supports issues. + Identifies and reports quality of care issues. + Prepares and presents cases… more
- Spectrum Health and Human Services (Orchard Park, NY)
- …practice guidelines. This role directs the day-to-day operations of the Quality Improvement Department, including utilization review, audit coordination, ... and coordinate QIC activities, tracking follow-up actions and outcomes. + Identify quality improvement priorities based on data analysis, audit results, and… more
- CVS Health (Albany, NY)
- …each and every day. Aetna's Revenue Integrity team is hiring Senior Coding Data Quality Auditors to support our growing risk adjustment efforts. This role plays a ... a passion for continuous improvement. This position will sit within our Coding Quality Operations team and offers the flexibility of working from home. **Position… more
- Trinity Health (Albany, NY)
- …or more years' experience as a risk adjustment auditor and educator and/or clinical documentation improvement specialist with a solid background in value-based ... Improvement - Certified Documentation Expert Outpatient (CDEO) or Certified Clinical Documentation Specialist -Outpatient (CCDS-O) preferred. **ESSENTIAL FUNCTIONS:**… more
- Highmark Health (Albany, NY)
- …retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, ... terminology and disease processes as it relates to the DRG/APC and other clinical data quality management factors. With technical direction and assistance from… more
- MVP Health Care (Schenectady, NY)
- …**Vendor Management & Performance Monitoring** + Manage external vendors supporting audit , analytics, and fraud detection. + Monitor vendor performance against SLAs ... ensure accountability. + Track and report key metrics such as recovery rates, audit turnaround times, and dispute resolution outcomes. **Fraud, Waste & Abuse (FWA)… more
- Mohawk Valley Health System (Utica, NY)
- …+ Provide guidance and advisory services to physicians, case managers and clinical documentation specialist regarding correct level of care and reimbursement. ... potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals… more
- Mohawk Valley Health System (Utica, NY)
- …to ensure effective and efficient coding operations. Also, this role will audit the most complex service records to ensure coding and documentation accuracy ... to improve Severity of Illness and Risk of Mortality. + Collaborate with Clinical Documentation Improvement (CDI) teams to optimize reimbursement and quality … more