• RN Medical Claim Review Nurse Remote

    Molina Healthcare (Albuquerque, NM)
    …care. For this position we are seeking an RN with previous Inpatient Hospital, Skilled Nursing Facility experience, and outpatient coding experience including ... care issues. * Assists with complex claim review including diagnosis-related group ( DRG ) validation, itemized bill review, appropriate level of care, inpatient more
    Molina Healthcare (10/19/25)
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  • Clinical Documentation Integrity Specialist (Per…

    Billings Clinic (Billings, MT)
    …$40.07 (+ $2.25/hr Per Diem Differential) The Clinical Documentation Specialist - Inpatient will conduct concurrent review of clinical documentation in the ... inpatient medical record with the goal to obtain the...the coding and compliance departments to ensure appropriate final DRG assignments and CC/MCC capture. In collaboration with the… more
    Billings Clinic (08/12/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Buffalo, NY)
    …reports quality of care issues. + Assists with Complex Claim review including DRG Validation, Itemized Bill Review, Appropriate Level of Care, Inpatient ... and coding experience. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Certified Clinical Coder , Certified Medical Audit Specialists, Certified Case Manager ,… more
    Molina Healthcare (10/18/25)
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  • Manager Compliance Coding

    Texas Health Resources (Arlington, TX)
    …procedures. Coding & Documentation Review - Assist the audit team with inpatient , outpatient, and provider coding assessments to ensure assigned codes are supported ... Certified Coding Specialist Upon Hire Required Or CPC - Certified Professional Coder Upon Hire Required Skills Strong understanding of leadership principles and best… more
    Texas Health Resources (10/15/25)
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  • Clinical Denials and Appeals-Clinical Supervisor

    Catholic Health (Buffalo, NY)
    …but not limited to clinical documentation/support for diagnostic related grouping ( DRG ) assignment, inpatient and outpatient medical necessity. The individual ... the following (or similar) credentials: Certified Documentation Specialist, Certified Coder (CPC/CCS), Certified Processional Medical Auditor (CPMA), Certified Case… more
    Catholic Health (10/01/25)
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  • Coding Specialist

    Kaleida Health (Buffalo, NY)
    …is responsible for coding, including, but not limited to any type of inpatient /or outpatient medical records for the purpose of data quality, accurate reimbursement, ... CCS certification is preferred as a Kaleida requirement. Certified Professional Coder (CPC)-grandfathered employees without HIM/Medical Records degrees who have this… more
    Kaleida Health (09/25/25)
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  • MedTech Billing & Coding Contract Specialist…

    Organon & Co. (Plymouth Meeting, PA)
    …including commercial, Medicare, and Medicaid. Serve as an expert on DRG hospital and provider reimbursement. + **Customer Engagement:** Provide customer-facing ... field (Master's preferred). + Professional certifications suggest certified professional coder (CPC, certified revenue cycle representative (CRCR), or certified… more
    Organon & Co. (09/06/25)
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  • Compliance Audit Manager

    Cardinal Health (San Juan, PR)
    …physicians, physician leadership, senior leadership, management, and staff; physician and coder education; and the making of recommendations for corrective action to ... and adequacy of documentation and coding related to physician or hospital ( inpatient and outpatient) billing and/or medical necessity reviews. + Manages focused… more
    Cardinal Health (08/27/25)
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