• Coding Auditor Educator-Inpatient

    Highmark Health (Richmond, VA)
    …related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, ... Contractor, the RAC, MIC, ZPIC, etc. Determine appeal action, prepare appeal letter follow up and identify education issues. (20%) + Develops audit detail summary… more
    Highmark Health (09/20/25)
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  • Provider Contract/Cost of Care Consultant (US)

    Elevance Health (Norfolk, VA)
    …Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider ... network satisfaction. Provides expert advice, analytic and consultative support to Medical Directors and management on cost of care issues. Works on large scale… more
    Elevance Health (10/07/25)
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  • Provider Contract Cost of Care Analyst Senior

    Elevance Health (Norfolk, VA)
    …Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider ... works with one provider type, eg physician, ancillary, or medical group. Provides advice and analytic support to ...and specialty care procedures and recommends policy changes and claim 's system changes to pursue cost savings. + Reviews… more
    Elevance Health (10/01/25)
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  • Healthcare Consultant II

    US Tech Solutions (Chesapeake, VA)
    … medical necessity/ appropriateness Facilitates optimal outcomes Identifies and follow through with continuous quality/ compliance opportunities. May also include ... all case management activities with members to evaluate the medical needs of the member to facilitate the member's...and multiple diagnoses that impact functionality. + Reviews prior claims to address potential impact on current case management… more
    US Tech Solutions (07/18/25)
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  • Manager, Medical Director - Transformation…

    Elevance Health (Norfolk, VA)
    **Manager, Medical Director - Transformation Initiatives** Location: This role requires associates to be in-office 3 days per week, fostering collaboration and ... granted as required by law. Alternate locations may be considered. The **Manager, Medical Director** will serve as a clinical and strategic advisor to enterprise… more
    Elevance Health (10/04/25)
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  • Business Architect Senior - Provider Systems

    Elevance Health (Norfolk, VA)
    …Provider selection logic; Provider setup configuration and roster loading/automation, claims system knowledge; external claim (EX) reviews/fixes; provider data ... and incentive bonus programs (unless covered by a collective bargaining agreement), medical , dental, vision, short and long term disability benefits, 401(k) +match,… more
    Elevance Health (09/30/25)
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  • Nurse Case Manager

    US Tech Solutions (Richmond, VA)
    …efficiency involving clinical issues Facilitates optimal outcomes. Identifies and follow through with continuous quality/ compliance opportunities . Educates/ ... including co-morbid and multiple diagnoses that impact functionality. + Reviews prior claims to address potential impact on current case management and eligibility.… more
    US Tech Solutions (07/18/25)
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  • Coding Quality Specialist 2

    University of Virginia (Charlottesville, VA)
    …documentation. + Reviews and resolves charge sessions that fail charge review edits, claim edits and follow -up work queues, identifies areas of opportunity based ... depending on their work assignment. + Reviews documentation in medical record to appropriately assign ICD-10-CM, CPT-4, HCPCS and...of errors. + Manages assigned charge review and coding-related claim edit work queues to ensure timely and accurate… more
    University of Virginia (09/17/25)
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  • Mgr II Grievance/Appeals- Medical Coding

    Elevance Health (Norfolk, VA)
    …+ Serves as a resource for complex issues and interpretation of claims , provider contracts and data, eligibility, member contracts, benefits, clinical decisions, ... and incentive bonus programs (unless covered by a collective bargaining agreement), medical , dental, vision, short and long term disability benefits, 401(k) +match,… more
    Elevance Health (09/24/25)
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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Richmond, VA)
    …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,...you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance… more
    Elevance Health (09/23/25)
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