- Houston Methodist (GA)
- …accuracy in code assignment of diagnosis and procedure to outpatient and/or inpatient encounters based upon documentation within the electronic medical record while ... rules and regulatory body guidelines. This position performs data quality review to ensure data integrity, coding accuracy, and revenue preservation. Additional… more
- Molina Healthcare (Columbus, GA)
- …Complex Claim review including DRG Validation, Itemized Bill Review , Appropriate Level of Care, Inpatient Readmission, and any opportunity identified ... set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience,… more
- Molina Healthcare (Columbus, GA)
- …all claim types of reimbursements not limited to payment methodologies such Stoploss, DRG , APC, RBRVS, FFS applicable for HD Inpatient , Outpatient and ... **Job Description** Responsible for comprehensive contract review and target claim audits review . This includes but not limited to; deep dive contract review … more
- Cardinal Health (Atlanta, GA)
- …and adequacy of documentation and coding related to physician or hospital ( inpatient and outpatient) billing and/or medical necessity reviews. + Manages focused ... data analytics and the revenue cycle team in identifying the time period of review and conducts a focused audit to identify any financial liability of the Company.… more
- Molina Healthcare (Savannah, GA)
- …**E** **N** **C** **E:** + Min. 6 years' experience in healthcare claims review and/or member dispute resolution. + 2 years leadership experience + Experience ... reviewing all types of medical claims (eg HCFA 1500, Outpatient/ Inpatient UB92, Universal Claims, Stop Loss, Surgery, Anesthesia, high dollar complicated claims, COB… more
- Molina Healthcare (Macon, GA)
- …experience. **Required Experience** * 7 years experience in healthcare claims review and/or member appeals and grievance processing/resolution, including 2 years in ... Experience reviewing all types of medical claims (eg HCFA 1500, Outpatient/ Inpatient UB92, Universal Claims, Stop Loss, Surgery, Anesthesia, high dollar complicated… more