- Cedars-Sinai (Beverly Hills, CA)
- …the enterprise through oversight over Oncology P&T and 13 Oncology DRG guideline development committees responsible for development of evidenced based guidelines. ... You will collaborate with the Clinical Efficiency Value team in developing innovative approaches in managing our oncology patients effectively. Be our designated Oncology PGY2 Residency Program Director (RPD).The RPD of the PGY2 training program to ensure the… more
- Sutter Health (San Francisco, CA)
- …and associated regulatory compliance requirements. + General understanding of coding and DRG assignment process preferred. + Must be able to effectively communicate ... with and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners. + Ability to work independently and exercise sound judgment in interactions with physicians, payers, and… more
- Scripps Health (San Diego, CA)
- …with HIPAA privacy requirements for patient information. * Basic understanding of DRG 's, Medical ICD9/ICD10 codes and CPT/HCPC Codes. * Ability to multitask and ... stay organized. * Good verbal and written communication skills. * Detail oriented and ability to prioritize work. * Requires a moderate level of interpersonal, problem solving, and analytic skills. * Knowledgeable on insurance and reimbursement process. *… more
- Sedgwick (Sacramento, CA)
- …experience processing work comp claims as an examiner. Familiar with CPT, DRG and resources established for "usual and customary". Experience handling legal ... inquiries. **Skills & Knowledge** + Strong organizational skills + Excellent negotiation skills + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills +… more
- Cardinal Health (Sacramento, CA)
- …of Medicare/Medicaid documentation and coding rules and guidelines; ICD/CPT/HCPCS/ DRG /APC documentation coding rules; medical terminology; E/M rules; healthcare ... compliance audit methodology, principles and techniques; ability to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation during audit reviews. + Ability to communicate complex and… more
- Sumitomo Pharma (Sacramento, CA)
- …+ Strong knowledge and experience with pharmaceutical data sources (ie, IQVIA, SHA, MMIT/ DRG formulary / market access data). + Strong knowledge and experience with ... patient and HCP market research and translating insights from research into actionable recommendations. + Strong understanding of omnichannel data and media promotion measurement (eg Crossix, Media Agencies, etc). + Proven success in developing analyses with… more
- Sumitomo Pharma (Sacramento, CA)
- …Strong knowledge and experience with pharmaceutical data sources (ie, IQVIA, SHA, MMIT/ DRG formulary / market access data). + Excellent team player and collaborative ... skills. + Strong project management skills and managing external vendors/ deliverables within tight timelines. + Strategic partner to multiple cross-functional stakeholders. + Proven success in developing analyses with Business Intelligence tools and methods… more
- LA Care Health Plan (Los Angeles, CA)
- …validation of accuracy and completeness of ICD, Rev Code, CPT, HCPCs, APR, DRG , POA, and all relevant coding elements. Audits can include inpatient, outpatient, and ... professional claims. Serves cross functionally with Utilization Management, Medical Directors, and other internal teams to assist in identification of overpayments as well as other projects. Serves as SME for all Payment Integrity functions to include both… more