- Elevance Health (Atlanta, GA)
- … principles, clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise, mastery of ... findings letters. + Maintains accuracy and quality standards as established by audit management. + Identifies potential documentation and coding errors by… more
- Datavant (Atlanta, GA)
- …headset, and keyboard + Comprehensive training led by a credentialed professional coding manager + Exceptional service-style management and mentorship (we're in ... attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a...ensuring precision and adherence to documentation + Oversee and audit the work of Level 1 & 2 Coders,… more
- Truist (Atlanta, GA)
- …efficient tools for regulatory monitoring. 4. Participate in compliance reviews, audit reviews, and remediation plan reviews to ensure solution development meets ... audit and regulatory requirements. 5. Develop FircoSoft Continuity and...regulatory requirements. 5. Develop FircoSoft Continuity and Trust tailored coding , software integration, perform analysis, configure solutions, using tools… more
- Elevance Health (Atlanta, GA)
- …and post implementation audits of providers, claims processing and payment, benefit coding , member and provider inquiries, enrollment & billing transactions and the ... data and makes recommendations for change based on judgment and experience, applies audit policy, and assesses risks to minimize our exposure and mitigate those… more
- Truist (Atlanta, GA)
- …efficient tools for regulatory monitoring. 4. Participate in compliance reviews, audit reviews, and remediation plan reviews to ensure solution development meets ... audit and regulatory requirements. 5. Build non-functional monitoring capabilities...Kafka) 5. Basic knowledge of Informatica (data mapping, ETL coding , file transformation) 6. Knowledge of Identity and Access… more
- Molina Healthcare (GA)
- …+ Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare ... be licensed for the state they reside This position will support Medical Review for Medicare and Marketplace request authorization. Strongly prefer candidates with… more
- CenterWell (Savannah, GA)
- …of inquiries, requests, and complaints from patients + Ongoing chart review / audit of clinical staff to ensure quality care and identifying opportunities for ... to both state and federalguidelines and regulations + Maintaining medical history and medical records + Ordering...HEDIS quality indicators + Good understanding of best practice coding and documentation in value based environment + Leveraging… more
- Emory Healthcare/Emory University (Decatur, GA)
- …of all material variances to the Clinical Administrator and Division Chief/ Medical Director. + Creates financial projections and feasibility analysis as needed ... to meet operational goals and comply with internal audit standards. + Manages costs and budgets for multiple...revenue cycle management and all associated components such as coding , charge submission, charge lag reduction and charge entry… more
- Elevance Health (Atlanta, GA)
- …based sponsorship. **Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective ... and accurate reimbursement criteria.** PRIMARY DUTIES: + Review medical record documentation in support of Evaluation and Management CPT codes. + Reviews company… more
- Elevance Health (Atlanta, GA)
- …abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. + Researches new healthcare related questions as ... as appropriate regarding approved interventions such as recovery of overpayment, pre-payment audit of claims or putting providers on notice. + Trains new associates.… more