- SUNY Upstate Medical University (Syracuse, NY)
- …OB/GYN encounters. This position serves as a key liaison between coding, clinical , and compliance departments ensuring that all documentation and coding ... The role also includes providing ongoing education to OB/GYN providers and clinical staff on documentation quality, coding updates, and best practices… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Primary Function/General Purpose of Position** Leads ... ongoing communication of risks, results and mitigation efforts. Develops appropriate documentation to support audit work performed. This position will primarily work… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …role conducts complex, risk-based audits across coding, charge capture, and documentation to assess adherence to government, payer, and institutional billing ... they arise across professional and hospital services, including coding accuracy, documentation sufficiency, charge capture, modifiers, and claim edits. Audits to be… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and represents non- clinical staff in discussions with Medical Directors and/or clinical consultants. + Serves as an internal auditor /peer reviewer for new ... of the SIU Management, this position is responsible for the accurate and thorough clinical investigation of potential fraud, waste and abuse (FWA) for all lines of… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …drivers. Essential Accountabilities: Level I + Handles physical health member clinical management programs. + Maintains knowledge of current Case Management Society ... or external referral sources. Applies case management criteria and professional clinical judgment to determine a member's appropriateness for case management… more
- CDPHP (Latham, NY)
- …or external referral sources. Applies case management criteria and professional clinical judgment to determine a member's appropriateness for case management ... Work collaboratively with all Case Managers, especially those with varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered… more
- Texas Health Resources (Arlington, TX)
- …ensuring documentation accurately captures a patient's health status and clinical condition. Proficiency in researching Medicare, OIG, CMS, and other regulatory ... establishing management correction plans when necessary. Additionally, the Compliance Auditor Manager effectively communicates audit findings through reports, presentations,… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …the Billing Compliance Reviewer plans and executes risk-based audits, analyzes documentation and coding for medical necessity and regulatory adherence, and ... Reviewer is responsible for developing clear findings, collaborating with clinical and administrative stakeholders to resolve issues, and supporting continuous… more
- Veterans Affairs, Veterans Health Administration (Reno, NV)
- …modifier usage for outpatient health records. Audit function includes evaluation of clinical documentation to support optimal code assignment. Reviews coding and ... / AAPC. (2) Mastery Level Certification through AHIMA / AAPC. (3) Clinical Documentation Improvement Certification through AHIMA or ACDIS. Grandfathering… more
- Aegis Therapies (Crosby, MN)
- …preferred. + Minimum 1 year of therapy management experience. + Currently Credentialed Documentation Auditor (CDA) or ability to become credentialed within six ... expectations are met + Plan, develop, implement, and monitor appropriate provision, documentation , billing of clinical services and customer relations. +… more