- CVS Health (Harrisburg, PA)
- …fraud waste and abuse business rules and leads designed to detect aberrant billing patterns and reviewing incoming referrals and leads to determine if additional ... Conduct proactive data mining and analysis if needed to identify suspicious billing patterns. **Required Qualifications** + 3-5 years of data interpretation and… more
- Corewell Health (Grand Rapids, MI)
- …abilities typically gained through related experience; health care operations, coding, billing , auditing and/or compliance experience + CRT-Professional Coder - ... including medical necessity, and compliance with other documentation, coding and billing standards. + Creates clear and accurate audit findings and recommendations… more
- Medtronic (MN)
- …physicians, home care agencies, case managers, hospital CFO's, medical directors, billing personnel, and pharmacists in clinics and hospitals. **Required Knowledge ... **Nice to have:** + Certified Coding Specialist (CCS) + Certified Professional Coder (CPC) **Physical Job Requirements** The above statements are intended to… more
- Queen's Health System (Honolulu, HI)
- …analytics, business or finance. B. CERTIFICATION AND LICENSURE: * Professional Coder certification from the American Academy of Professional Coders (AAPC) preferred. ... including familiarity with government and third-party payer reimbursement and payer billing rules and guidelines preferred * Experience with Epic preferred. *… more
- Parkview Health (Huntington, IN)
- …Parkview Health Systems/PRMC including Flight and EMS services. Determines appropriate coding/ billing charges according to written procedures and criteria as it ... a Medical Terminology course preferred. Licensure/Certification Must obtain Certified Ambulance Coder , within 1 year of hire and maintain throughout employment.… more
- Ochsner Health (New Orleans, LA)
- …System (CTMS) to guide users in accurate data recording to prevent billing errors, ensuring data integrity and compliance. To perform this job successfully, ... (CHPC), Certified in Healthcare Research Compliance (CHRC), Certified Professional Coder (CPC), Certified Coding Specialist (CCS) or related certification.… more
- Commonwealth Care Alliance (Boston, MA)
- …TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical ... sets to provide analysis and reports on existing provider billing patterns as compared to industry standard coding regulations,...within 1 year of employment - + Certified Professional Coder (CPC) + Certified Inpatient Coder (CIC)… more
- CareFirst (Baltimore, MD)
- …the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality and STARs outcomes while not ... of medical codes across policies and platforms. The Senior Coding Analyst partners with medical policy analysts, configuration teams, and payment integrity… more
- Commonwealth Care Alliance (Boston, MA)
- …to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring accurate, compliant, and timely reimbursements ... issues - including underpayments, overpayments, and disputes. The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare,… more
- Penn Medicine (Philadelphia, PA)
- …professional fee coding across all entities to ensure timely and optimal billing and reimbursement to support established Health Information Management and Revenue ... Manager also assists with the routine development of CFA department coordinator and analyst staff, the hiring of qualified candidates, as well as develops, maintains… more