- Elevance Health (St. Louis, MO)
- …is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of business, and ... submitted DRG. **How you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines and objectivity in… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …improvements for Core back-Office systems including but not limited to: Core Healthcare Claims Processing Platform including Eligibility & Enrollment (Group, ... with a strong emphasis on quality control and improvements to enhance claims processing stability, flexibility, and innovation. The Director will be responsible for… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation. + Maintains awareness of fraud, waste and ... protocols which align with Bon Secours Mercy Health's overall compliance audit and compliance responsibilities relative to hospital revenue cycle services performed… more
- Elevance Health (Costa Mesa, CA)
- …and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes and audits claims ... coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise, mastery of… more
- UNC Health Care (Rocky Mount, NC)
- …Health Nash, an affiliated member of the UNC Health system, invites passionate healthcare professionals to join our esteemed team. Governed locally, we proudly serve ... dedication to wellness, where we constantly strive to redefine excellence in healthcare through state-of-the-art facilities and pioneering programs. Join us in this… more
- Independent Health (Buffalo, NY)
- …will aid in training other team members, evaluating appeals, and share audit trends across the team. Expertise and proficiency demonstrated by long-standing, ... ability to train others, to identify coding patterns and share knowledge and audit tips across the team. The Clinical & Coding Specialist-Senior will support the… more
- Highmark Health (Springfield, IL)
- …responsible for assisting in the processing and investigation of non-complex health care claims to determine the legitimacy of claim charges. The incumbent will also ... services and charges; will monitor internal referrals from sources such as claims , customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert… more
- City of Boise (Boise, ID)
- …This role is pivotal in coordinating workers' compensation and liability claims , insurance renewals, and risk-related investigations. The right candidate is ... Processes, investigates and provides recommendations for liability and workers' compensation claims by compiling, verifying the accuracy of, completing research and… more
- Henry Ford Health System (Detroit, MI)
- GENERAL SUMMARY: Under the direction of the Compliance Audit Manager, the Principal Compliance Investigator will oversee compliance auditing and monitoring to assess ... all levels of the organization. + Writes and reviews audit programs, audit work papers, and ...one or more of the following areas: Utilization Management, Claims , Pharmacy Operations, Compliance, FDR oversight activities, Quality Management,… more
- Independent Health (Buffalo, NY)
- …coding and documentation. The incumbent is also responsible for assisting in the claims review, medical record capture and review, and identification of the one best ... record to verify CMS HCC submission as assigned per CMS RADV audit specifications. The Analyst is going to assist the manager in training coding integrity associates… more