- Avera (Sioux Falls, SD)
- …management. **What you will do** + Review all aspects of a patient's clinical documentation in order to identify the appropriate sequence of ICD-10-CM diagnosis and ... on these topics on occasion. + Queries physicians and clinical documentation staff to ensure a full capture of...and guidance from coding guideline references as needed for appeals . + Maintains personal quality and production statistics in… more
- Avera (Sioux Falls, SD)
- …management. **What you will do** + Review all aspects of a patient's clinical documentation in order to identify the appropriate sequence of ICD-10-CM, CPT, and ... other health professionals within Avera on coding related topics. + Queries physicians and clinical documentation staff to ensure a full capture of the clinical … more
- System One (Baltimore, MD)
- …as needed. Clinical Medical Review Nurse / Medical Records Abstraction Specialist Schedule: 8-hour shifts (start time 8:00 or 8:30 AM); onsite training twice ... Job Title: Clinical Medical Review Nurse Location: Baltimore, MD 21224...handles day-to-day review of professional and institutional claims, provider appeals , and medical record abstraction to determine benefit eligibility… more
- Centene Corporation (Jefferson City, MO)
- …to audit errors + Coordinate auditing outcomes and system maintenance with the Sr. + Clinical Systems Specialist to resolve or enhance clinical systems + ... the auditing of corporate, health plan, and specialty company staff related to clinical systems entry and/or processes + Develop and maintain the audit process and… more
- Cedars-Sinai (Beverly Hills, CA)
- …care. Use Milliman and Interqual guidelines as necessary. + Collaborates with clinical teams and practices to ensure synchronization of sub-areas' operations to ... Investigates, processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate policy. + Begins… more
- City of New York (New York, NY)
- …schools across New York City. OSH provides NYC Health Code-mandated clinical services, public health initiatives, chronic disease management, reproductive health ... services. - Attend to the health needs of designated school community. - Provide direct clinical services to an assigned panel of schools. - Serve as a consultant to… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …initiatives in collaboration with the Director of Operations, Quality Improvement Specialist , and Utilization Management. The role involves providing support and ... consultation for utilization management (medical and pharmacy), appeals , medical policy (development and maintenance), and quality improvement (Medicare Stars,… more
- Community Health Systems (Franklin, TN)
- …authorizations and reduce potential denials, utilizing input from the Utilization Review Clinical Specialist . + Monitors and updates case management software ... and effective management of utilization review processes, including denials and appeals activities. This role collaborates with payers, hospital staff, and … more
- Mount Sinai Health System (New York, NY)
- …provider data management that will feed or interface with all applicable clinical and administrative enterprise systems, centralize all provider performance data and ... _Director, Medical Affairs Operations_ will play a pivotal role in a dynamic, clinical /operational environment by serving as the point person in the management of… more
- Commonwealth Care Alliance (Boston, MA)
- …provider community. In this highly visible field position, the provider relations specialist acts as the primary liaison between CCA and its providers including ... policies related to: Claims and service recovery; Program benefits; Clinical initiatives; Referral and authorization; Regulatory compliance; Billing and payments;… more