- Guidehouse (St. Paul, MN)
- …remote **What You Will Do** **:** + Under the direction of the Director of Revenue Integrity, the Revenue Integrity Coding Billing Specialistprovides revenue cycle ... services through efficient review and timely resolution of assigned Medicare and third party payer accounts that are subject...Coding Initiatives (CCI) + Medically Unlikely Edits (MUE) + Medical Necessity edits + Other claim level edits as… more
- Centene Corporation (Helena, MT)
- …for appeals, adjustments and miscellaneous/unlisted code review + Review cases with Medical Director to validate decisions and identify opportunities to create ... medical records, claims history, state regulations, contractual obligations, corporate policies and procedures and guidelines established by the American … more
- Molina Healthcare (Las Vegas, NV)
- …experience, including: + Minimum 5 years clinical practice. + 5 years in a Medical Director role. + 4 years HMO/Managed Care experience, including Utilization ... **Job Description** **Job Summary** The Health Plan Chief Medical Officer provides leadership in the development and execution of the Plan's disease management, case… more
- Atlantic Health System (Morristown, NJ)
- …The Joint Commission, state standards, and other regulatory requirements. Supports medical and nursing staff to optimize nutrition care through evidence-based ... members. + Maintains quality assurance and evaluates compliance with corporate policies and procedures and State and Federal guidelines....Our facilities and sites of care include: + Morristown Medical Center, Morristown, NJ + Overlook Medical … more
- Excellus BlueCross BlueShield (Rochester, NY)
- …external standards set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case ... identifies and refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate communication techniques with members and… more
- Sharp HealthCare (San Diego, CA)
- …the implementation of correct coding standards by clinical providers as established by SHC Corporate Compliance in accordance to the CMS and local MAC ( Medicare ... requirements. **Required Qualifications** + 3 Years experience auditing coding and medical record documentation in an ambulatory care setting. + Experience… more
- Medtronic (Minneapolis, MN)
- …counsel to cross functional partners (Marketing, Regulatory, Legal, R&D, Clinical, Medical Science, Corporate and Global reimbursement counterparts) and business ... endovascular aortic repair therapies, included US commercial, Medicaid and Medicare Advantage programs, working closely with cross-functional colleagues, including… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …external standards set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case ... identifies and refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate communication techniques with members and… more
- Humana (Sacramento, CA)
- …segment's highest priority projects and initiatives, with an emphasis on Medicare Advantage strategy development. As a Senior Strategy Advancement Professional, you ... subject matter experts, members of Humana's executive Management Team, and corporate , functional, and business unit leaders. Recent example projects include… more
- Whidbey General Hospital (Coupeville, WA)
- …issues with other departments as needed. + Ensures completion of admission medical necessity reviews within 24 hours of admission. Completes concurrent inpatient ... medical necessity reviews daily, unless otherwise specified by payer....a minimum of every 12 hours (twice daily). Completes Medicare extended stay reviews, as appropriate. + Identifies and… more