- ProMedica Health System (Toledo, OH)
- …compliant documentation and coding practices, including regulatory changes or updates. Reviews medical record documentation and claims data to ensure compliance ... and HCPCS coding. Advanced knowledge of anatomy and physiology and medical terminology. In-depth knowledge of reimbursement systems and prospective payment… more
- Sedgwick (Cincinnati, OH)
- …to callers regarding claims for multiple lines of business; to expedite the claims application process and provide detailed claim notes on all calls; to ... Inbound call center experience preferred. **Skills & Knowledge** + Knowledge of medical terminology + Understanding of claims management + Excellent oral… more
- CDM Smith (Cincinnati, OH)
- …**Business Unit:** FSU **Job Description:** CDM Smith is seeking a Forensic Accounting Specialist with expertise in disaster fraud claims . This role is critical ... in evaluating and analyzing financial data related to disaster-related claims , including property damage, business interruption, and other loss categories. The … more
- Elevance Health (Mason, OH)
- …coding or quality assurance environment preferred. + Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement ... -expense spending. The **DRG CODING AUDITOR** is responsible for auditing inpatient medical records and generating high quality recoverable claims for the… more
- Cardinal Health (Columbus, OH)
- …skills and prioritizes getting the right things done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. ... and support from AR & Billing leadership teams.** **_Responsibilities_** + Processes claims : investigates insurance claims ; and properly resolves by follow-up &… more
- Highmark Health (Columbus, OH)
- …related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, ... and ensures compliance with DRG/APC structure and regulatory requirements. Performs periodic claim form reviews to check code transfer accuracy from the abstracting… more
- OhioHealth (Marion, OH)
- …**Minimum Qualifications:** High School or GED (Required) **Additional Job Description:** BWC claim process, paperwork and/or medical office experience a plus. ... Responsible for patient referrals and tracking to achieve effective and prompt medical treatment planning. Coordinates with external case managers to insure timely… more
- OhioHealth (Columbus, OH)
- …2. Provides guidance to the failed claims team who works internal failed claims and also works with departments regarding medical necessity issues to ensure ... including quality, productivity, coder training/education, physician onboarding/education and failed claims for the OhioHealth Network and OhioHealth Physician Enterprise.… more
- Insight Global (Cincinnati, OH)
- …develop and support various projects, coordinate and design studies to support product claims , and ensure all product claims comply with global regulations. ... to consumer data focus groups to gather insights. The specialist will also conduct update meetings to ensure team...to ensure team alignment and write defensives about product claims . Preferred candidates will have the ability to assess… more
- Elevance Health (Mason, OH)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... claims . **How you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in… more