- Zelis (St. Petersburg, FL)
- …outpatient claims for Health Plans and TPA's to ensure adherence to proper coding and billing, analyzing inpatient DRG claims based on industry standard inpatient ... coding guidelines, and supporting the Office of the Chief...CIC,RHIA , RHIT, CPC or equivalent credentialing). + Registered Nurse licensure preferred + Bachelor's Degree Preferred in business,… more
- Atlantic Health System (Morristown, NJ)
- …capture accurate representation of the severity of illness and facilitate proper coding .Validates that coding reflects medical necessity of services and ... facilitates appropriate coding which provides an accurate reflection and reporting of...required, experience in ICU strongly preferred + Registered licensed nurse (RN) required + Strong clinical knowledge in respiratory… more
- UCLA Health (Los Angeles, CA)
- …and other related actions + Ability to work effectively with common office software, coding software, and EMR systems + Registered Nurse (RN) or clinical ... Adjustment, you will be an expert in risk adjustment coding and documentation, working closely with physicians, IPA coders,...physicians (MD, DO, or NP) to ensure documentation and coding accuracy of ICD-10 CM codes related to chronic… more
- Centene Corporation (Lansing, MI)
- …the position. **A license in one of the following is preferred:** Certified Coding Specialist (CCS), Licensed Practical Nurse (LPN), Licensed Master Social Work ... education for HEDIS measures, appropriate medical record documentation and appropriate coding . Assists in resolving deficiencies impacting plan compliance to meet… more
- UPMC (Pittsburgh, PA)
- …the analysis of care and services related to clinical guidelines, coding requirements, regulatory requirements, and resource utilization. This role also acts ... claims, medical records and associated processes related to the appropriateness of coding , clinical care, documentation, and health plan business rules. + Provide a… more
- Elevance Health (Seven Hills, OH)
- …not limited to: + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit ... activities. + Draws on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions. + Utilizes audit tools,… more
- CGI Technologies and Solutions, Inc. (Dallas, TX)
- …defender of payment accuracy, reviewing complex medical records to ensure that coding and reimbursements for Commercial and Government health plans are precise and ... well-supported. You will leverage your deep inpatient coding expertise and clinical intuition to identify improper payments while producing thoroughly documented… more
- Redeemer Health Home Care & Hospice (Meadowbrook, PA)
- …Medical or Surgical Inpatient Care Nursing, as an RN, Physician Assistant (PA), Nurse Practitioner (NP)/Advanced Practice nurse (APN), medical school graduate OR ... both manual and automated versions of the ICD 10 coding classification systems is preferred + Previous experience in...Must possess one of the below: + Current Registered Nurse License + Registered Health Information Administrator (RHIA) +… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and identifies actionable opportunities for providers to improve their Quality and Coding Accuracy performance. The role leads face-to-face meetings with leaders in ... plans. The consultants are in-house subject matter experts on coding accuracy and Quality programs such as including HEDIS...in Health Care Quality and Manager (CHQM) * Registered Nurse * Solid knowledge of Medicare Advantage Business Compensation… more
- Hartford HealthCare (Farmington, CT)
- …1 is responsible for extensive record review, and interaction with physicians, HIM coding professionals, nursing staff and other patient care givers to ensure the ... . Meets program quality and productivity guidelines and standards. . Participates in Coding /CDI meetings and CDI H3W work group. . Inputs review workflows and… more