- Elevance Health (Wallingford, CT)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role enables associates to work virtually ... as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to identify opportunities for...Experiences:** + Fraud and Abuse experienced Nurse with a CPC are highly desired. For candidates working in person… more
- Cardinal Health (Hartford, CT)
- …conducts investigations to resolve ethics and compliance issues. **Compliance Audit Manager ** Reporting to the Compliance Director, this position supervises and ... manages compliance audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services. This position… more
- Humana (Hartford, CT)
- …part of our caring community and help us put health first** The Manager , Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. ... The Manager , Fraud and Waste works within specific guidelines and...Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Decisions… more
- Hartford HealthCare (Farmington, CT)
- …and largest revenue generating clinical departments. Under the direction of the Manager Revenue Integrity Analyst - Clinical Liaison, the Revenue Integrity Analyst I ... Documentation Improvement (CDI), and other departments with resolution of billing issues and/or denials requiring clinical expertise, participating in external… more
- Hartford HealthCare (Farmington, CT)
- …adjustment program requirements and ICD 10 coding guidelines. Reporting to Manager of Audit and Education **_Position Responsibilities:_** **Key Areas of ... Relationships:_* *This Job Reports To:* Audit and Education Specialist Manager *_Requirements and Specifications:_* **Education** . Minimum: o Medical Coding… more
- Moses/Weitzman Health System (CT)
- …in a healthcare billing and collections office **OR** 2) Coding Certification/ Billing Certificate Program (AAPC's CPC or AHIMA's CCA) with 2 years' ... to achieve a high level of productivity + Notifies Manager of information that negatively impacts production + Assist...experience in a healthcare billing and collections office + In depth knowledge of… more
- Hartford HealthCare (Farmington, CT)
- …diagnostic results. Extracts data and assigns alpha numeric codes for billing , internal and external statistical reporting, research, regulatory compliance and ... . Cardiac Catheterizations . LifeStar . Orthopedic . Critical Care 7. Assists manager with special projects/other tasks as assigned 8. Abides by the Standards of… more
- Hartford HealthCare (Farmington, CT)
- …diagnostic results. Extracts data and assigns alpha numeric codes for billing , internal and external statistical reporting, research, regulatory compliance and ... Infusion Services o Electrophysiology o Cardiac Catheterizations o Orthopedic 6. Assists manager with special projects/other tasks as assigned 7. Abides by the… more
- Hartford HealthCare (Newington, CT)
- …Exchange) and Premier system edits * Utilize Cobius Institutional Audit Manager (IAM) software to streamline audits, communicate findings, and simplify reports. ... Association and adheres to official coding guidelines This position reports to Manager Hospital HIM Coding Quality and Education *Education:* Associates Degree or… more
- Hartford HealthCare (Farmington, CT)
- …team the findings. *_Working Relationship:_* *This Job Reports To (Job Title): * Manager Audit and Education. *Education* . Minimum: High School Diploma . Preferred: ... and Management o Experience with interpreting Medicare, Medicaid and third-party billing and compliance regulations necessary. . Preferred: o Experience working with… more