- Elevance Health (Mendota Heights, MN)
- …Identifies potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for ... **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This...medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and coding … more
- Hartford HealthCare (Hartford, CT)
- …of the Office of Compliance and Integrity (OCI) by executing clinical documentation, coding and billing audits as assigned or scheduled. The Revenue Compliance ... Auditor performs independent reviews to assess compliance with federal,...as intended. . Stays up to date on documentation, coding and billing regulations and requirements via… more
- UPMC (Pittsburgh, PA)
- …AHA coding clinics, ICD-10-CM or government regulations. + Review provider coding / billing trends, and government audit outcomes to identified HCC coding ... has an exciting opportunity for a Risk Adjustment Clinical Auditor /Analyst position in the Medicare department. This is a...are supported within the audit year, and utilize AHA Coding clinics, ICD-10-CM Coding Guidelines, CPT … more
- St. Luke's University Health Network (Allentown, PA)
- …In doing so, works with providers and their office staff, as well as the Coding and SLPG Billing Department. JOB DUTIES AND RESPONSIBILITIES: + Perform quality ... to pay for health care. The Network Provider Services Auditor performs audits as part of the Documentation and...auditing software program. + Is a resource to the coding department, SLPG practices, providers, and billing … more
- Premera Blue Cross (Mountlake Terrace, WA)
- …pre-payment and post-payment claim audits to identify improper payments due to billing errors, coding discrepancies, and policy non-compliance. Audits include ... reviewing medical records, applying clinical and coding knowledge, analyzing provider billing patterns, and evaluating related claim history to ensure accurate… more
- Elevance Health (MD)
- …as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations. + Collaborates ... **Clinical Provider Auditor II** **Supports the Payment Integrity line of...an impact:** + Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities for fraud… more
- Insight Global (South Jordan, UT)
- Job Description Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100% remote. This person should have an extensive background in ... either facility-based nursing, clinical documentation, and/or inpatient coding and has a high level of understanding of reimbursement guidelines specifically an… more
- Bozeman Health (Bozeman, MT)
- …The role partners with departments across the organization to assess billing , coding , privacy/security, and operational practices; identifies vulnerabilities; ... Position Summary: The Compliance Auditor supports an effective compliance program by planning...field. + Intermediate knowledge and experience reviewing clinical documentation, billing , and coding for compliance. + Intermediate… more
- Elevance Health (Atlanta, GA)
- …as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations. + Collaborates ... **Clinical Provider Auditor I (CPC)** **Hybrid 1:** This role requires...an impact:** + Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities for fraud… more
- Elevance Health (Norfolk, VA)
- …as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations. + Collaborates ... **Clinical Provider Auditor II** **Location:** _Hybrid1:_ This role requires associates...an Impact:** + Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities for fraud… more