• DRG Denials Auditor

    Community Health Systems (Franklin, TN)
    …improve coding practices and compliance. **Essential Functions** + Performs inpatient denial reviews using ICD-10-CM/PCS and DRG validation utilizing ... **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits for both...LPN, RN, MD, PA, or DO preferred + CCS-Certified Coding Specialist required or + RHIT -… more
    Community Health Systems (09/09/25)
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  • HIM Cert Coder/Quality Review Analyst OP Team B

    Carle Health (Champaign, IL)
    …Associate (CCA) - American Health Information Management Association (AHIMA); Certified Coding Specialist (CCS) - American Health Information Management ... for billing. This position also reviews and response to coding -based denials for inpatient , hospital outpatient and...HIM coding team member group education on coding topics identified during quality reviews and denial… more
    Carle Health (10/29/25)
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  • RN Medical Claim Review Nurse Remote

    Molina Healthcare (Albuquerque, NM)
    … Inpatient Hospital, Skilled Nursing Facility experience, and outpatient coding experience including diagnosis. Candidates with knowledge of CPT/HCPCS codes, ... of member services in alignment with state, federal, accrediting, and billing/ coding guidelines and regulations. Contributes to overarching strategy to provide… more
    Molina Healthcare (10/19/25)
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  • Manager - Utilization Review

    Minnesota Visiting Nurse Agency (Minneapolis, MN)
    …when appropriate * Collaborates with department director and professional development specialist to develop standard work and expectations for the utilization review ... care team * Collaborates with nursing, physicians, admissions, fiscal, legal, compliance, coding , and billing staff to answer clinical questions related to medical… more
    Minnesota Visiting Nurse Agency (09/30/25)
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