- Elevance Health (Independence, OH)
- …Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **INVESTIGATOR II** is responsible for the identification, ... claims. **How you will make an impact:** + Claim reviews for appropriate coding , data mining, entity review, law enforcement referral, and use of proprietary data… more
- Elevance Health (Mason, OH)
- …Analyst II- Pharmacy Benefit Auditor** is responsible for analyzing pharmacy benefit coding systems against business criteria. The primary focus is to work on ... Capabilities and Experiences:** + CPhT is preferred. + Pharmacy plan benefit coding and/or pharmacy plan quality review experience strongly preferred. + Pharmacy… more
- Bon Secours Mercy Health (Lorain, OH)
- …team for optimal patient flow and quality outcomes + Reviews patient medical records , performs screening assessments (to assess physical, psychological, ... - (preferred) Uniform Data System (UDS) and Quality Indicators - (preferred) Medical Terminology and Coding - (preferred) **Language** None **Patient… more
- Kelly Services (Blue Ash, OH)
- …position with competitive compensation and a comprehensive benefits package including medical , dental, 401k, and paid time off. **Title:** Administrative Assistant ... + Other duties as assigned Office Site Management: + Perform office manager role for Cincinnati Preclinical Nonclinical Laboratory Research Facility. + Manage all… more
- Elevance Health (Mason, OH)
- …Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. Partners ... non-routine reviews. Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request to assess assessing… more
- Molina Healthcare (Cleveland, OH)
- …the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, ... pharmacy, etc.). + Experience demonstrating knowledge of ICD-9, CPT coding and HCPC. + Experience demonstrating knowledge of CMS...+ Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager … more
- Bon Secours Mercy Health (Oregon, OH)
- …**Knowledge, Skills, and Abilities:** High school graduate or GED required. Medical Terminology, ICD-9 and CPT coding experience required. Computer/typing ... skills of at least 40 wpm. Medical secretary, medical assistant program...consent forms, and maintains file system for confidential patient records . 6. Reviews visit data, determines appropriate ICD-9 code… more
- Elevance Health (Mason, OH)
- …and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. + Researches new healthcare related questions as ... provide an equivalent background. **Preferred Skills, Capabilities, and Experiences:** + Coding Certificate or Registered Nurse preferred. Please be advised that… more
- Elevance Health (Mason, OH)
- …based sponsorship. **Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective ... and accurate reimbursement criteria.** PRIMARY DUTIES: + Review medical record documentation in support of Evaluation and Management CPT codes. + Reviews company… more
- CenterWell (Columbus, OH)
- …treats center patients in accordance with standards of care. + Follows level of medical care and quality for patients and monitors care using available data and ... the care team through daily huddles. + Helps Associate Medical Director (AMD), Physician and Center Administrator in setting...manner working with a quality- based coder to optimize coding specificity. + Follows policy and protocol defined by… more