- CVS Health (Jefferson City, MO)
- …day. **Position Summary** Responsible for conducting complex audits, reviews and assessments of medical records coded by internal teams prior to the submission ... ) **or** CCS-P (Certified Coding Specialist-Physician) and CRC (Certified Risk Adjustment Coder ) required. + CPMA (Certified Professional Medical Auditor) **or**… more
- Independent Health (Buffalo, NY)
- …+ Responsible for all reconsideration clinical appeals to include review of records , consultation with Medical Director, response to facilities as well ... fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist- Senior will be responsible for reviewing coding and clinical decisions on… more
- CareFirst (Baltimore, MD)
- …, provider and subscriber medical data, claims, systems reports, medical records , analysis of contract documents, provider/subscriber claims history, ... **Resp & Qualifications** **PURPOSE:** The role of the Special Investigations Unit (SIU) Senior Investigator is to assist in the reduction and recuperation of losses… more
- Humana (Columbus, OH)
- … Coding Educator is responsible for reviewing and analyzing internal data and medical records , as well as coordinating educational sessions with providers to ... part of our caring community and help us put health first** The Senior Coding Educator identifies opportunities to improve provider documentation, coding and creates… more
- Elevance Health (Atlanta, GA)
- …and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. + Researches new healthcare related questions as ... **Clinical Fraud Investigator Senior ** **Location:** _Hybrid1:_ This role requires associates be...in Nursing and/or current certification as a Certified Professional Coder (AAPC or AHIMA) and minimum of 5 years… more
- Elevance Health (Mason, OH)
- …formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Nurse Audit Senior ** will be responsible ... **Nurse Audit Senior - Payment Integrity Complex and Clinical Audit**...impact:** . Investigates potential fraud and over-utilization by performing medical reviews via prepayment claims review and post payment… more
- CVS Health (Hartford, CT)
- …each and every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Special Investigations Unit (Aetna SIU). ... of time for business purposes. **Preferred Qualifications** + Certified Professional Coder (CPC), AHFI, CFE + Bilingual English/Spanish + Dental Investigative… more
- CenterWell (Fort Worth, TX)
- …Care Organization is one of the largest and fastest growing value-based care, senior -focused primary care providers in the country, operating over 210 centers across ... care team supporting patient's physical, emotional, and social wellness. At CenterWell Senior Primary Care, we want to help those in the communities we… more
- CenterWell (Des Moines, IA)
- … Medical Coding Professional extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical ... and Advanced Practice Providers) to ensure the documentation within medical records supports diagnostic and procedural coding. **Relationship/Concierge… more
- CenterWell (Atlanta, GA)
- …Care Organization is one of the largest and fastest growing value-based care, senior -focused primary care providers in the country, operating over 340 centers across ... care team supporting patient's physical, emotional, and social wellness. At CenterWell Senior Primary Care, we want to help those in the communities we… more
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