- Centene Corporation (Jefferson City, MO)
- …policies, regulatory codes, legislative directives, precedent, AMA and CMS code edit criterion + Review medical records to ensure billing is consistent with ... through a comprehensive review and analysis of medical claims, medical records , claims...medical record for appeals, adjustments and miscellaneous/unlisted code … more
- SSM Health (MO)
- …improvement and the need for accurate and complete documentation in the health record . + Attends department meetings to review documentation related issues. ... and the need for accurate and complete documentation in the health record , including attending physicians and allied health practitioners. Collaborates with coding… more
- US Tech Solutions (May, OK)
- …complete the screenings. * Search for relevant HEDIS records from databases, review medical records using HEDIS technical specification criteria or ... Participates in the member and provider outreach, collection, and review of medical records to...offices as needed to schedule/confirm appointments, follow up on medical record submission, and provide patient rosters… more
- The Joint Commission (Oakbrook Terrace, IL)
- …Field Representatives, with minimal direction or supervision, survey and/or review health care organizations throughout the United States. Field Representatives ... **Responsibilities** Position Accountabilities: + Ability to analyze and synthesize survey/ review findings to provide conclusions, recommendations and educational opportunities.… more
- Aston Carter (Downers Grove, IL)
- …*Assists in review and information lookup in LexisNexis of violation records with license plates that cannot be acquired through SOS or Nlets. *Identifies ... motivate and develop a team of Violation Reviewers, to assist Violation Review Supervisor(s), process supervisor approvals while also performing tasks of a Violation… more
- Centene Corporation (Atlanta, GA)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care + Conduct peer reviews with… more
- Centene Corporation (Frankfort, KY)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care + Conduct peer reviews with psychologist… more
- Catholic Health (Buffalo, NY)
- …Exempt: Yes Work Schedule: Days Hours: 8:00am-4:00pm Summary: Conducts audits of medical records within defined guidelines to ensure compliance with ... York State RN license + Valid drivers license EXPERIENCE + 3-5 years Medical Surgical experience required. + 3-5 years Home Care clinical experience preferred (CHHA,… more
- AmeriHealth Caritas (LA)
- …When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health ... facilitate timely authorizations and optimize patient care. + Analyze medical records and clinical data to ensure...prior authorization experience is required.; + Proficiency in Electronic Medical Record Systems to efficiently document and… more
- AmeriHealth Caritas (Washington, DC)
- …When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health ... facilitate timely authorizations and optimize patient care + Analyze medical records and clinical data to ensure... medical office setting + Proficiency in Electronic Medical Record Systems to efficiently document and… more