- CVS Health (Lansing, MI)
- … review , diagnosis coding, and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition ... records coded by internal teams prior to the submission to the Centers of Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are… more
- Trinity Health (Ypsilanti, MI)
- …third-party authorizations, referrals) and contacts physicians and Case Management/Utilization Review personnel, as needed. Obtains and verifies the accuracy and ... completeness of physician orders for tests and procedures, which includes name,...third-party authorizations, referrals) and contacts physicians and Case Management/Utilization Review personnel, as needed. Obtains and verifies the accuracy… more
- Banner Health (MI)
- …knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group (APR-DRG) and Ambulatory Payment ... and ethical coding compliance. If applicable, initiates and follows through on physician queries to ensure that code assignment accurately reflects the patient's… more
- Evolent (Lansing, MI)
- …interacts with leadership and management staff, other Physicians, and staff whenever a physician `s input is needed or required. As well as, aids and acts as ... the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Tenet Healthcare (Detroit, MI)
- …level of care based on Medical Necessity process and submits case for Secondary Physician review per Tenet policy. Ensures timely communication of clinical data ... the following activities: a) accurate medical necessity screening and submission for Physician Advisor review , b) care coordination, c) transition planning… more
- Fresenius Medical Center (Dearborn Heights, MI)
- …(QD). + Evaluate intradialytic problems and provide intervention as prescribed by physician order or as directed. + Monitor patients' response to dialysis therapy ... the designated clinical application accurately and in a timely manner. + Review treatment sheets for completeness ensure nursing signatures are documented and ensure… more
- Fresenius Medical Center (Ypsilanti, MI)
- …(QD). + Evaluate intradialytic problems and provide intervention as prescribed by physician order or as directed. + Monitor patients' response to dialysis therapy. ... the designated clinical application in an accurate and timely manner. + Review treatment sheets for completeness, ensure nursing signatures are documented, and… more
- Cardinal Health (Lansing, MI)
- …and keep updated on policy or procedural changes + Investigate and resolve patient/ physician inquiries and concerns in a timely manner + Enter detailed information ... or customer service environment, preferred + Clear knowledge of Medicare , Medicaid & Commercial payer policies and guidelines for...other status protected by federal, state or local law._ _To read and review this privacy notice click_ here… more
- CVS Health (Lansing, MI)
- …to identify and submit ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are ... of 1 year recent and related experience in medical record documentation review , diagnosis coding, and/or auditing. + Completion of AAPC/AHIMA training program for… more
- Trinity Health (Livonia, MI)
- …and HCPCS codes and modifiers. Maintains current knowledge of Medical Necessity review guidelines for commercial, Medicare and Medicaid insurance products, ... **Employment Type:** Full time **Shift:** **Description:** **POSITION PURPOSE** Analyzes physician /provider documentation contained in Outpatient health records to perform… more