- UPMC (Pittsburgh, PA)
- UPMC Health Plan has an exciting opportunity for a Clinical Auditor /Analyst position in the CCBH Fraud, Waste & Abuse department. This is a full time position ... consisting of working from home and in office. The Clinical FWA Auditor /Analyst is the entry level...+ Knowledge of behavioral health Medicaid programs, preferred, and services within the Commonwealth of Pennsylvania. + Ability to… more
- Surgery Care Affiliates (Birmingham, AL)
- …as well as support SCA Health' s compliance program . The Senior Clinical Auditor will work with all Support Services departments , as well as interact ... we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence...a member of the Regulatory Compliance Team, the Senior Clinical Auditor will conduct compliance focused … more
- Centene Corporation (New York, NY)
- …findings, including clinical recommendations to assure the delivery of quality services + Lead case reviews to assess the clinical performance provided ... flexibility. **Position Purpose:** Lead medical record audits, monitor and analyze clinical documentation, and modify business processes to measure member outcomes.… more
- Molina Healthcare (NM)
- …+ Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management (CM), Member ... Management (HM), and/or Disease Management (DM). + Monitors key clinical staff for compliance with NCQA, CMS, State and...NCQA, CMS, State and Federal requirements. May also perform non- clinical system and process audits, as needed. + Assesses… more
- Healthfirst (NY)
- …and Responsibilities:** + Conduct quality audits of A&G items cases grievances, pre- service appeals, and post service appeals utilizing appropriate sources of ... classified, and fully resolved in a compliant manner. + Review clinical documentation for accuracy, completeness identifying any discrepancies or non-compliance… more
- Community Health Systems (Sarasota, FL)
- (Full-Time, Remote) The Clinical Review Analyst is a professionally licensed nurse/LPN who is responsible for effectively managing the denial/appeal process via the ... performance of comprehensive analytic reviews of clinical and claim documentation. The CRA will perform triage, determine payment viability; and draft and submit… more
- UNC Health Care (Chapel Hill, NC)
- …from entity to entity across the state to train and shadow round with Clinical Documentation Specialists. The CDS auditor provides elbow to elbow support during ... Summary: This positon trains and audits Inpatient and Outpatient Clinical Documentation Specialists (CDS) across all HCS entities that...are owned or managed that have opted into shared services . This position reports to the HCS Supervisor Coding… more
- The County of Los Angeles (Los Angeles, CA)
- … services programs to ensure, proper utilization of funds and provision of services . + Consults with clinical , administrative, and program planning staff in ... through the allocation of various categorical funds available to specific contract service agreements. + Evaluates proposals for contract services ; supervises… more
- Novant Health (Charlotte, NC)
- Job Summary The Compliance Auditor is responsible for conducting provider documentation audits to assess compliance with documentation, coding, and billing ... but are not limited to, inpatient and outpatient professional services , ancillary services (ex., labs, imaging), procedures...ICD-10 diagnosis coding. As part of these audits, the Auditor identifies trends that may pose risks to individual… more
- Eurofins (Des Moines, IA)
- …+ Significant knowledge of audit subject matter - particularly social audits, service delivery methodologies for audit services and the demonstrated ability ... sciences company, providing a unique range of analytical testing services to clients across multiple industries, to make life...forensics, advanced material sciences and in the support of clinical studies, as well as having an emerging global… more