• Special Investigation Unit (SIU) Coding Review…

    CVS Health (Albany, NY)
    …the team in determining correct coding and appropriate documentation during the review of medical records . This role requires a strong focus on meeting state, ... Coder (CPC) Manager will oversee a team of medical coders within the Special Investigations Unit (SIU) to...that may warrant a prepayment review. + Maintain appropriate records , files, and documentation for the team. + Utilize… more
    CVS Health (08/08/25)
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  • Clinical Reimbursement Manager; HSO Drg…

    Mount Sinai Health System (New York, NY)
    …the beneficiary's medical record. Responsible for performing quality reviews of medical records to validate correctness and appropriateness of the assigned ... **Responsibilities** Performs SMART focused reviews on ICD-10-CM/PCS coded inpt medical records to validate accuracy of codes... diagnoses or conditions that are clinically evident. Reviews coder queries to determine if the query is supported… more
    Mount Sinai Health System (07/17/25)
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  • Coding Data Quality Auditor

    CVS Health (Albany, NY)
    …every day. **Position Summary** + Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD codes ... all State and Federal regulations and internal policies and procedures. + Utilize medical records to ensure support is documented for etiology and manifestations… more
    CVS Health (08/09/25)
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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Latham, NY)
    …Related Group Clinical Validation Auditor** is responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions ... you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of … more
    Elevance Health (08/09/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Yonkers, NY)
    …the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, ... more of the following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional… more
    Molina Healthcare (08/02/25)
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  • Auditor, HCC Risk Adjustment Coding - Full Time…

    Datavant (Albany, NY)
    …experiences to realize our bold vision for healthcare. As an Auditor, HCC Risk Adjustment Coder , you will review medical records to identify and code ... across Medicare, commercial, and Medicaid sectors. + In-depth knowledge of medical terminology, abbreviations, pharmacology, and disease processes. + Ability to… more
    Datavant (08/08/25)
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  • Inpatient Clinical & Coding Specialist - Senior

    Independent Health (Buffalo, NY)
    …+ Responsible for all reconsideration clinical appeals to include review of records , consultation with Medical Director, response to facilities as well ... one of the following certifications or licensures: Certified Inpatient Coder (CIC), Registered Health Information Management Administrator (RHIA), Registered Health… more
    Independent Health (07/15/25)
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  • Senior Coding Educator

    Humana (Albany, NY)
    …Senior Coding Educator is responsible for reviewing and analyzing internal data and medical records , as well as coordinating educational sessions with providers ... or equivalent + Must hold AAPC CPC (Certified Professional Coder ) certification + 2 years or more experience with...Prior experience in provider education + Strong knowledge of medical record review + Understanding of billing, claims submission,… more
    Humana (08/08/25)
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  • LCSW-R School Based Health Cen

    Bassett Healthcare (Sidney, NY)
    …and community support services as required Maintains ongoing patient records , documents therapeutic interventions and progress in achieving treatment goals ... in accordance with department standards for billing of services Provides coder /analyst with timely, accurate, and adequate billing information following each patient… more
    Bassett Healthcare (07/16/25)
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