- Elevance Health (Tampa, FL)
- ** Clinical Documentation and Claims Integrity Director** **Location:** **Virtual:** This role enables associates to work virtually full-time, with the ... through home-care and community based services. **The Clinical Documentation and Claims Integrity Director** will lead CareBridge's efforts in diagnostic… more
- University of Miami (Miami, FL)
- …essential to support strategic goals. Charge Capture & Revenue Analysis + Review clinical documentation and charge data to ensure accurate and complete billing. ... Working under the direction of the Director of Revenue Integrity Systems, the analyst collaborates with clinical ...This position plays a pivotal role in ensuring revenue integrity through: trend reporting and claims analysis,… more
- Molina Healthcare (Tampa, FL)
- …with appeals, claims review, and medical coding. **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ... + Performs clinical /medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which an appeal has been submitted, to… more
- Banner Health (FL)
- …patient care. POSITION SUMMARY This position is responsible for the interpretation of clinical documentation completed by the health care team for the health ... record(s) and for quality assurance in the alignment of clinical documentation and billing codes. Works with...findings. 4. Acts as a knowledge resource to ancillary clinical departments, patient financial services and revenue integrity… more
- MyFlorida (Hudson, FL)
- …but is not limited to client information, dates of services, and payment of claims . Assists Program Manager in compiling and reviewing program data to complete all ... monitors Patient Reporting Forms (PRFs), client eligibility, and tracks missing documentation needed to complete each case. Processes vouchers and referrals.… more
- Elevance Health (Tampa, FL)
- …for all lines of business, and its clients. Also responsible for performing clinical reviews of medical records and other documentation to evaluate issues ... accommodation is granted as required by law._ Carelon Payment Integrity is a proud member of the Elevance Health...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical… more
- Carnival Cruise Line (Miami, FL)
- …Management** + Escalate high-risk crew cases to risk management, legal, HR, and clinical governance teams. + Review crew claims for relevance and appropriateness ... timely, empathetic communication and resolution of high-complexity cases involving clinical , legal, and logistical challenges. Key responsibilities include reviewing… more
- Evolent (Tallahassee, FL)
- …risk adjustment coding team and operations, ensuring accurate and timely ICD-10 coding of claims via progress note clinical documentation review. + Ensure ... and that impact the team. Provide individual and team training on clinical documentation requirements, risk adjustment coding guidelines, and updates. +… more
- Carnival Cruise Line (Miami, FL)
- …Communicate with crew and their families with professionalism and empathy. + Review clinical care plans for appropriateness and support the case management team in ... compliance with regulations and employment obligations. + Support disability claims and benefits review for crew unable to return...attention of risk management and the case management (MD), clinical governance, legal, and HR teams. + Review crew… more
- MyFlorida (Jacksonville, FL)
- …and reports tobacco cessation referrals made at outreach events and at DOH clinical locations. + Provides requested support to team members (program manager, peers, ... 7: Financial planning/Management skills + Input FBCCEDP client's billing invoices and claims into electronic databases. + Track paid invoices and maintain files for… more
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