- Elevance Health (Tampa, FL)
- …based sponsorship. **Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective ... and accurate reimbursement criteria.** PRIMARY DUTIES: + Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code. +… more
- Ochsner Health (New Orleans, LA)
- …and regulatory requirements to ensure compliance. + Collaborate with clinical staff and coding teams to obtain necessary documentation for appeals + Track and ... make a difference at Ochsner Health and discover your future today!** The Appeals Specialist is responsible for managing and resolving insurance claim denials and… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …will be considered. * 3 years of relevant health plan or provider office medical coding /claims and/or Business Analyst experience in a healthcare setting ... Cross and Blue Shield of Minnesota Position Title: Healthcare Coding Analyst Location: Hybrid | Eagan, Minnesota... appeals assuring that federally and state mandated coding rules are followed and that the medical… more
- Healthfirst (FL)
- …policy disputes and appeals . + Reviews claims editing escalated provider disputes/ appeals and provides guidance on coding rules and industry standards across ... configuration to resolve the provider payment discrepancies. + Reviews medical records to ensure coding is consistent...discrepancies. + Reviews medical records to ensure coding is consistent with the services billed and compares… more
- UPMC (Pittsburgh, PA)
- …Auditor/Analysts. + Provide new-hire training to Clinical Auditor/Analysts. Performing administrative appeals /preparing medical necessity appeals for ... Medical Directors for second level appeals . Participate in training programs to develop a thorough...and organize multiple projects and tasks. In-depth knowledge of medical terminology, ICD-10 and CPT-4 coding . Knowledge… more
- Huron Consulting Group (Chicago, IL)
- …internal processes and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and ... internal processes and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and… more
- LA Care Health Plan (Los Angeles, CA)
- …(CRA-HCC (TM) ); NAMAS Certified HCC Coder (CHCC (TM) ); AHIMA Certified Coding Specialist (CCS(R)) Domain Focus: Medical Cost Driver Analytics Required: ... Enterprise Data Analyst III Job Category: Administrative, HR, Business Professionals...Key Performance Indicators (KPIs) (eg, turnaround times, denial rates, appeals outcomes) and translate data into actionable insights. Domain… more
- LA Care Health Plan (Los Angeles, CA)
- …(CRA-HCC (TM) ), NAMAS Certified HCC Coder (CHCC (TM) ), AHIMA Certified Coding Specialist (CCS(R)). Domain Focus: Medical Cost Driver Analytics Required: ... Solutions and Data Analyst III Job Category: Administrative, HR, Business Professionals...to analyze operational KPIs (eg, turnaround times, denial rates, appeals outcomes) and translate data into actionable insights. Domain… more
- LA Care Health Plan (Los Angeles, CA)
- Enterprise Data Analyst II Job Category: Administrative, HR, Business Professionals Department: Enterprise Analytics Location: Los Angeles, CA, US, 90017 Position ... safety net required to achieve that purpose. Job Summary The Enteprise Data Analyst II collaborates and contributes in the design, development, and delivery of… more
- Robert Half Accountemps (Los Angeles, CA)
- …Revenue Cycle Processes, Medical Claims, Billing Functions, UB-04 form, HMO PPO, Medical Appeals , Medical Denials, and Epic Software. Robert Half is ... National Healthcare Organization is in the need of a Medical Revenue Cycle Analyst to join its...for improvement within the revenue cycle processes, including billing, coding , collections, and reimbursements. + Maintain and analyze financial… more