- CVS Health (Columbus, OH)
- …each and every day. **Position Summary** The Quality Specialist will audit pre and post payment claims for accuracy and eligibility transactions. They ... identifying errors, necessary corrective measures, and may participate in special audit assignments. **Required Qualifications** + 1+ years of experience working in… more
- Bon Secours Mercy Health (Oberlin, OH)
- …Bon Secours Mercy Health, we are dedicated to continually improving health care quality , safety and cost effectiveness. Our hospitals, care sites and clinicians are ... recognized for clinical and operational excellence. **_Patient Access Specialist - Mercy Allen Hospital (Oberlin, OH)_** **This is a PRN "As Needed" Position**… more
- Trinity Health (Columbus, OH)
- …wide variety of professional roles including information technology, financial analysis, audit , provider relations and more. **About the job:** Member Service ... agencies. Implements retention strategies to maintain current membership and improve the quality of care and service **What you'll do:** + Complies with internal… more
- Banner Health (OH)
- …coding expertise to resolve issues and support appropriate reimbursement. Proficiency in claims software to address coding edits and claim denials utilizing ... to work and receive care. In this **Inpatient Facility/HIMS Certified Medical Coder, Quality Associate** position, you bring your **5 years of acute care inpatient… more
- Elevance Health (Mason, OH)
- …letters. + Maintains accuracy and quality standards as set by audit management for the auditing concept, valid claim identification, and documentation ... responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of...purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside… more
- Elevance Health (Mason, OH)
- …and reference information to generate audit determinations and formulate detailed audit findings letters. + Maintains accuracy and quality standards as ... clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise,...Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation… more
- Molina Healthcare (Dayton, OH)
- …following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare ... of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of… more