- State of Georgia (Fulton County, GA)
- …across both program areas. + Troubleshoot and resolve escalated GHVP claims -related issues, including payment denials, corrections, and recoupments. + Review ... or customer account management + Experience in moderate accounting and the review and explanation of financial ledger details, vendor/payment records, and/or account… more
- Arizona Public Service (Phoenix, AZ)
- …providing clear, business-aligned guidance on commercial matters. + Draft, review , and negotiate complex commercial agreements, including procurement, licensing, ... years of commercial, corporate, or transactional law experience. + Contract Specialist : Strong background drafting and negotiating complex commercial agreements. +… more
- University of Southern California (Los Angeles, CA)
- …compliance regulations and guidelines, the Coding Compliance Auditor performs 2nd level review of previously coded accounts to ensure appropriate CPT, ICD-10-CM, and ... and Athena IDX in a manner to assure clean claims release for billing in a timely manner. Participate...95% accuracy rate as determined by an annual external review of coding. + UNDER GENERAL SUPERVISION, RESPONSIBLE FOR… more
- Houston Methodist (Houston, TX)
- …departments. + Responds to or clarifies internal requests for coding review by coders or department representatives. **QUALITY/SAFETY ESSENTIAL FUNCTIONS** + Ensures ... Practice and performs associated actions upon non-compliance (ie, focal point review requirements, disaster plan, in services, influenza immunization, wage and hour,… more
- Centene Corporation (Lansing, MI)
- …improve provider performance in areas of Quality, Risk Adjustment and Operations ( claims and encounters). + Assists in delivering provider specific metrics and ... work experience within a managed care environment related to HEDIS record review , quality improvement, medical coding or transferable skill sets that demonstrates… more
- Lundbeck (Deerfield, IL)
- …files, and developing clear analytical summaries and visual presentations for review by the Compliance Committee and Executive Leadership Team. + **Risk ... monitoring and auditing program. + **System Support:** Serve as system support specialist for the compliance program management software, as needed. + **Third Party… more
- SRP (Tempe, AZ)
- …attend design reviews, evaluates bids, make recommendations to management, review drawings, perform factory inspections, witness testing, and perform equipment ... engineering assistance for equipment field installation, startup, troubleshooting and warranty claims . + Participate in vendor quality management and lead equipment… more
- United Musculoskeletal Partners (Atlanta, GA)
- …the patient visit, the patient is ready for check out.The Checkout Specialist works in a fast-paced environment, providing outstanding customer service to all ... patients. General duties include insurance benefit review with the patient, collection of time of service...in the EMR system at Check-Out + Submits appropriate claims for Real Time Adjudication + Works "Day End… more
- University of Rochester (Rochester, NY)
- …**ESSENTIAL FUNCTIONS** + Uses knowledge of coding systems and system logic to review codes created by electronic charge capture and/or assigns codes through medical ... reviews to make corrections before transmittal. + Troubleshoots problems that prevent claims from being released. Identifies cause of edit and independently resolves… more
- Intermountain Health (Murray, UT)
- …medical directors and various leadership members. + Prepares appeals for review by appropriate committees, internal medical directors, and specialty physician ... through available education and individual research. + Provides expertise on claims adjudication and benefits for all plans, including commercial, self-funded,… more