- LA Care Health Plan (Los Angeles, CA)
- HEDIS Abstractor II (Temporary) Job Category: Clinical Department: Quality Performance Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....HEDIS gaps. Conducts audits and provides HEDIS education at provider offices and provides feedback to office staff and… more
- Commonwealth Care Alliance (Boston, MA)
- …on edits implemented. + Utilize data to examine large claims data sets to provide analysis and reports on existing provider billing patterns as compared to ... Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and necessary coding configuration requirements… more
- CenterLight Health System (NY)
- …processes. It involves acting as a liaison between coding operations and clinical staff, training and coaching medical personnel on coding guidelines, and ensuring ... the accuracy and timeliness of clinical documentation. Additionally, the role includes analyzing and optimizing...for ensuring that all services /disciplines in the Practice provide coordinated care and excellent communication with all disciplines… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …drivers. Essential Accountabilities: Level I * Handles behavioral health member clinical management programs. * Maintains knowledge of current Case Management ... or external referral sources. Applies case management criteria and professional clinical judgment to determine a member's appropriateness for case management… 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
- Corewell Health (Grand Rapids, MI)
- …of legal counsel and works with legal counsel during such investigation to provide guidance, recommendations and other assistance as requested by legal counsel. In ... related work experience + Health care operations, auditing and or compliance + Compliance auditor , nurse auditor , or other audit function + One of the following… more
- Molina Healthcare (Scottsdale, AZ)
- …provider outreach initiatives. + Supports provision of high-quality clinical care and services by facilitating/building strategic relationships with health ... and implements targeted interventions related to performance improvement, including member and provider outreach to improve care and service. + Serves as operations… more
- Brockton Hospital (Brockton, MA)
- Signature Healthcare is Southeastern Massachusetts' premier local provider of quality, personalized medical services. We are comprised of the award-winning ... government program requirements. Clearly communicate such requirements to management, clinical and operations staff. Conducts and coordinates compliance investigations… more
- Johns Hopkins University (Baltimore, MD)
- …responsible for all billing compliance and training programs for Johns Hopkins Medicine's clinical care providers. The Senior Director is a member of the senior ... management team of the School of Medicine's Clinical Practice Association (CPA) and the Office of Johns...auditing activities by the federal government, the university's external auditor , or third-party insurers as related to billing compliance.… more
- Kelly Services (Lake Mary, FL)
- **Nurse Aide Evaluator Quality Assurance Coordinator** Kelly(R) Science & Clinical is seeking an NAE QA Coordinator for a direct hire position at a leading client in ... standards and company guidelines. This position requires a blend of clinical nursing experience, quality assurance expertise, and strong interpersonal skills to… more