- Nuvance Health (Danbury, CT)
- …findings for educational programs for both coding personnel and clinical staff.Requires advanced expertise in medical terminology, anatomy, physiology, ... CPC-H, or CCS-P AAPC or AHIMA required* *Certified Professional Medical Auditor (CPMA) or Certified Documentation Expert Outpatient (CDEO) required* Company: Western… more
- FlexStaff (Chappaqua, NY)
- **Req Number** 166292 FlexStaff is seeking an experienced Compliance Auditor with experience in physician medical billing and coding for one of our clients, a ... experience in medical billing and coding * Experience with auditing and monitoring clinical records and documentation In this role you will be reviewing and… more
- Highmark Health (Helena, MT)
- …as needed. Attends meetings and interacts with management to resolve issues and provide advice on new programs. Provides guidance to system entities in response to ... and disease processes as it relates to the DRG/APC and other clinical data quality management factors. With technical direction and assistance from management,… more
- Humana (Phoenix, AZ)
- …us put health first** CenterWell Senior Primary Care (PCO) is a growing provider organization that currently operates about 340+ senior focused primary care centers ... business partners to uphold ethical standards and mitigate risks. The Senior Clinical Compliance Professional will support the Director of Compliance, by ensuring… more
- Baystate Health (Springfield, MA)
- …the work is administrative. **Job Responsibilities:** **1)** Performs detailed reviews of clinical documentation for provider services using MDAudit based on ... determined intervals per provider . Validates appropriate billing and documentation that complies with...applicable use of all carrier guidelines and review of clinical documentation. **5)** Receives and screens incoming correspondence, reports,… more
- Ascension Health (Wichita, KS)
- …accuracy of billing through verification of coding, billing and supporting clinical documentation. + Coordinate all activities associated with insurance carrier ... professional licensure at time of hire. **Additional Preferences** Experience with clinical appeals preferred. Experience with denials and coding strongly preferred.… more
- Atlantic Health System (Morristown, NJ)
- …assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines and provide ongoing feedback and analysis of the education needs for the providers ... and testing records for physician practices. + Evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation that could impact… more
- Northwell Health (Westbury, NY)
- …a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist- Clinical . Conducts Home Health Resource Group (HHRG) Validation to ensure the ... + Instructs professional staff in code changes, as needed. + Assists clinical staff and nursing supervisors in providing appropriate documentation in the Medical… more
- US Tech Solutions (Hopewell, NJ)
- …year-end reports. **Responsibilities:** + Conducts on-site reviews at participating provider offices to assess environment, quality of physicians medical records, ... + Assists the Quality Management department with various special projects and focused clinical studies. + Performs related tasks or special studies as requested. +… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Summary** Works collaboratively with the Compliance ... external third party claims payment peer analysis systems to detect provider -billing trends, potential fraudulent or abusive billing practices or vulnerabilities… more