- Sedgwick (Columbus, OH)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Disability Clinical Specialist **PRIMARY PURPOSE** : To perform clinical ... to discuss employee's clinical status, progress and work status. + Achieves appropriate quality audit scores on a consistent basis. + Acts as clinical … more
- Elevance Health (Mason, OH)
- …we are actively defining our innovative role in the industry. **Pharmacy Quality Assurance Specialist ** **Location:** This role requires associates to be ... as required by law._ **Schedule: Monday - Friday; 8:00am-5:00pm** The **Pharmacy Quality Assurance Specialist ** is responsible for evaluating the quality… more
- Prime Therapeutics (Columbus, OH)
- …our passion and drives every decision we make. **Job Posting Title** SIU Specialist - Pharmacy Tech - Remote in the California market **Job Description** Responsible ... in accordance with procedures or to present to management to recommend for audit or investigation. Serves as a corporate resource on fraud, waste and abuse… more
- Elevance Health (Mason, OH)
- …and reference information to generate audit determinations and formulate detailed audit findings letters. + Maintains accuracy and quality standards as ... state(s). + Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years… more
- Molina Healthcare (Cincinnati, OH)
- …+ 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
- CVS Health (Columbus, OH)
- …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
- Elevance Health (Mason, OH)
- …preferred. + Experience with vendor based DRG Coding / Clinical Validation Audit setting or hospital coding or quality assurance environment preferred. + ... of business, and its clients. Also responsible for performing clinical reviews of medical records and other documentation to...information to make audit determinations and generate audit findings letters. + Maintains accuracy and quality… more
- Highmark Health (Columbus, OH)
- …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
- OhioHealth (Marion, OH)
- …purpose of the position is to direct, monitor and provide quality credentialing/privileging and re-credentialing/privileging processes to ensure that physicians and ... to medical providers, this individual interacts with medical staff office(s), quality management, compliance, medical staff and hospital leadership, and other… more