- Elevance Health (Atlanta, GA)
- ** Clinical Provider Auditor I ( CPC )** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and ... granted as required by law.** The ** Clinical Provider Auditor I ( CPC )** is...or any combination of education and experience, which would provide an equivalent background. + Must achieve coding certification… more
- Virtua Health (Mount Laurel, NJ)
- …practitioners equipped with the latest technologies, treatments, and techniques to provide exceptional care close to home. A Magnet-recognized health system ranked ... Coding Audit Response: Conducts Trains new coders to utilize the medical record, clinical , coding and abstracting systems, in conjunction with UHDDS and other rules… more
- Atlantic Health System (Morristown, NJ)
- …assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines and provide ongoing feedback and analysis of the education needs for the providers ... and testing records for physician practices. + Evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation that could impact… more
- Elevance Health (Norfolk, VA)
- ** Clinical Provider Auditor II** **Location:** _Hybrid1:_ This role requires associates be in the office 1-2 days per week, fostering collaboration and ... an accommodation is granted as required by law. The ** Clinical Provider Auditor II** is...provide an equivalent background. + Requires coding certification ( CPC , CCS, CPMA). **Preferred Skills, Capabilities, and Experiences:** +… more
- Elevance Health (MD)
- ** Clinical Provider Auditor II** **Supports the Payment Integrity line of business** **Location: Must be located in Maryland.** This field-based role enables ... is determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Provider Auditor II** is responsible for identifying… more
- UPMC (Pittsburgh, PA)
- UPMC Health Plan has an exciting opportunity for a Risk Adjustment Clinical Auditor /Analyst position in the Medicare department. This is a full time position ... Friday daylight hours and will be fully remote.. The Clinical Auditor /Analyst is an integral part of...outcomes, government audit outcomes, or ad hoc reviews. + Provide a clinical opinion for special projects… more
- Elevance Health (Denver, CO)
- **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This role enables associates to work virtually ... Shift:** Monday - Friday 8AM -5PM (local time) The **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG)** is responsible… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Plans' provider agreements and the National Healthcare guidelines. The Professional Auditor helps improve clinical outcomes and quality of care, to reduce ... true colors to blue. About the Role: The Professional Auditor is responsible for post-pay review to verify the...post-pay review to verify the accuracy of claims reimbursement, clinical significance, coding, and billing in accordance with the… more
- CVS Health (IN)
- …Coder) required **Preferred Qualifications** + CPMA (Certified Professional Medical Auditor ), CDEO (Certified Documentation Expert Outpatient) or CPC -I ... risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal...+ Leads dispute resolution. + Acts as mentor to provide education to internal staff based on audit findings;… more
- Guthrie (Sayre, PA)
- Option to be Hybrid/Remote. Summary: A senior level compliance coding auditor conducting assessments in accordance with The Guthrie Clinic's policies and procedures ... and billing and/or compliance field required 5 year of clinical experience and/or knowledge and understanding of Medical Records...Records auditing process preferred. + Required to sit for CPC exam within one year. Education: + Associates degree… more