- University of Southern California (Arcadia, CA)
- …coding conventions and guidelines and applies to ongoing evaluation of medical record documentation. + Designs and implements in collaboration with physician ... leadership specific tools to support medical record physician documentation. + Facilitates multidisciplinary team in...and written communication skills. + Able to compose coding appeals based on documentation, coding guidelines and Coding Clinic… more
- Buffalo Hearing & Speech Center (Buffalo, NY)
- …billing as assigned individually by the accounts receivable manager. Experience in Medicare and Medicaid HMO's, Commercial payers such as ChampVA, Tricare, UHC, ... up is to be done bi-monthly on assigned controls to include corrected claims, appeals , phone calls, or provider rep assistance to assure any missing or incorrect… more
- LA Care Health Plan (Los Angeles, CA)
- …and Outreach, Ansafone, Web Inquiries, MRU (Member Relations Unit), and Appeals and Grievance, performance against key performance indicators and recognizes trends ... daily error reports, analyze results from Call Center, MRP, Medicare , MRU, Outbound and Outreach, and LA Care Covered...and Member Relations Unit). Provides unit managers and departmental director with analysis on the error trends and provide… more
- Huron Consulting Group (Chicago, IL)
- …internal processes and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and ... agencies, and hospital contractual payor agreements. This position reports to the Director of Utilization Management and works with hospital leadership to coordinate… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …with BCBSMA criteria to adjudicate these requests. At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also ... quality improvement activities + Perform additional tasks as assigned by the Associate Medical Director of the Physician Psychologist Review Unit + Adhere to… more
- Medtronic (CA)
- …of this job description. In this role, you will report to the Director , Reimbursement and Health Economics for the Neurosciences. You will work independently with ... modifiers, and documentation requirements. + Support customers in navigating Medicare , Medicaid, and commercial payer coverage policies and prior-authorization… more
- Cedars-Sinai (Beverly Hills, CA)
- …Express) no later than date of discharge. + Communicates regularly with CSMPN Medical Director , Employee Health Services, Risk Management, and TPA + Attends ... 19 years in a row for providing the highest-quality medical care in Los Angeles. We were also awarded...and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate policy.… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …teaching the Care Coordination Department; serving as a member of the medical staff; and coordinating with Hospital leadership on matters regarding progression of ... patient care, medical necessity, compliance with regulatory guidelines, payer relationships; clinical...Assist with the segmentation of concurrent review offerings into Medicare / Medicaid / Commercial Payors, as needed *… more
- Sharp HealthCare (San Diego, CA)
- …venues.Escalate and refers cases for consultation with Physician Advisor or Medical Director as appropriate.Oversee preparation, delivery and documentation of ... utilization standards as set by community and professional standard as adopted by the medical staff.The RN CM I will assure that the patients from all age groups… more
- Sharp HealthCare (La Mesa, CA)
- …venues.Escalate and refers cases for consultation with Physician Advisor or Medical Director as appropriate.Oversee preparation, delivery and documentation of ... utilization standards as set by community and professional standard as adopted by the medical staff.The RN CM will assure that the patients from all age groups… more