Clinical Appeals Audit Specialist jobs

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Oct 17 Registered Nurse (Clinical Specialist) - Permanent Job Yoh Staffing Los Angeles, CA

Grievances and Appeals Clinical Auditing Specialist needed for a direct hire ... against key performance indicators- Clinical Quality Auditing Specialist... more

Oct 09 RN Appeals Specialist(275895) Kaiser Permanente Oakland, CA

Description The Clinical Appeals Coordinator/Specialist reviews communications from member ... others such as Project Appeals Specialist, to meet compliance deadlines Qualifications... more

Jul 23 Director of Compliance Audits and Appeals (RN) Archcare New York City, NY

for a job. Director of Compliance Audits and Appeals (RN) Job ID 2013-6523 # Positions 1 ... to improve compliance. Serves as appeals specialist for nursing homes, coordinating,... more

Jun 30 Physician Pro Fee Coding Specialist II CHS Corporate Franklin, TN

and ability to evaluate and summarize clinical records to support successful appeal Reasoning Ability: * Proven analytical and organizational ability. * Ability to define... more

More Job Postings from the Web
Oct 23 Registered Nurse (Clinical Specialist) - Permanent Job Yoh Los Angeles, CA

Grievances and Appeals Clinical Auditing Specialist needed for a direct hire ... against key performance indicators - Clinical Quality Auditing Specialist... more

Oct 22 Customer Srvc Representative Coventry Health Care Philadelphia, PA

() Handles incoming requests for appeals and pre-authorizations not handled by Clinical Cl ... LICENSES AND CERTIFICATIONS Customer Service/Associate Customer Service Specialist is desi... more

Oct 22 Coding & Audit Specialist, CPC / CCS-P, Days (Coder, Quality, Auditor) St. Mary Medical Center Langhorne, PA

and Procedure. Perform peer audits. Perform clinical documentation improvement audits, ... Identify and report coding errors to Coding/Audit Lead and LPS Billing Director... more

Oct 21 Enrollment Specialist Cap Management Phoenix, AZ

Prepare any appeals/submissions to the CMS Retroactive Processing Contractor (RPC) when th ... Requires 3 years as an enrollment specialist or equivalent health plan experience. more

Oct 21 Specialist Quality Improvement and Compliance HealthNow New York Buffalo, NY

utilize resources from outside vendors, clinical staff, provider network, and ... and responsibilities, and grievances and appeals. Collaborate with top performing... more

Oct 20 Coding Supervisor Physcian Practice-Coding Banner Health Greeley, CO

regulatory standards. Coordinates the audit review process. Assures results are ... and education. Requires Certified Coding Specialist (CCS) or Certified Professional... more

Oct 18 Home Health Quality Assurance Manager Gentiva Union, SC

and accreditation results. * Audit charts for clinical oversight and ... with the Clinical Leadership and clinical associate staff in resolving complex... more

Oct 18 Director of Health Information Management Crystal Clinic Orthopaedic Center Akron, OH

Responsible for directing external audit response programs including RAC, ZPIC, ... Certified Coding Specialist (CCS) and/or Certified Documentation Improvement Professional... more

Oct 17 Quality Improvement Specialist Catholic Health Initiatives Federal Way, WA

Summary The Quality Improvement (QI) Specialist will support Medical Management in ... Facilitate the spread of excellent clinical and service quality for all Soundpath... more

Oct 17 Clinical Utilization Management Specialist-CSC Job Blue Cross and Blue Shield of Minnesota Saint Paul, MN

Clinical Utilization Management Specialist-CSC (Job Number:10589) Description Summary: ... departments. Accountabilities: 1. Applies clinical experience, health plan benefit... more

Oct 17 Provider Network Data Specialist - 133894 Banner Health Phoenix, AZ

cardiovascular care in an environment of clinical excellence, compassion and healing. ... departments in resolving provider and member appeals pertaining to the physician,... more

Oct 16 Coding Reimbursement Analyst 2 University of Florida Gainesville, FL

of clinical data when ambiguous information is encountered. • Facilitate and improve ... Specialist (CCS-P) (American Health Information Management Association) or Certified... more

Oct 15 Specialist, Regulatory Compliance I | Health Plans University of Arizona Health Network Arizona

Qualifications: Regulatory Compliance Specialist I * Finance Knowledge of ... telephone standards knowledge. Grievance and Appeals background * Network Development... more

Oct 15 Quality Improvement Specialist Alegent Creighton Federal Way, WA

Summary The Quality Improvement (QI) Specialist will support Medical Management in areas ... Facilitate the spread of excellent clinical and service quality for all Soundpath... more

Oct 14 Utilization Management Specialist - Full Time (80 hours) - FSS - Highline Region (0000) Catholic Health Initiatives Burien, WA

* Facilitates the achievement of consistent clinical outcomes by concurrently assessing ... advisor. *Researches and prepares written appeals in response to third party payor... more

Oct 14 MEDICAL CODER SPECIALIST Nasher Museum of Art Durham, NC

Provide education/training to physicians and other providers on coding and clinical docume ... accounts. Contacts appropriate personnel for clinical documentation inefficiencies. more

Oct 14 Complaints Specialist - Multiple Locations UnitedHealth Group Latham, NY

Preferred Qualifications: * Previous Appeals and/or Complaints/Grievances experience. * Previous Claims experience. * Bachelor's Degree in Healthcare, Behavioral Health, Business,... more

Oct 13 Coding Specialist Ime Resources Redding, CA

consider this opportunity.   The Coding Specialist is responsible to create and write ... location and available for audit at all times. * Processes client invoicing in... more

Oct 13 Director Physician Appeals and Special Projects Cqi Executive Search Minnesota

Director Physician Appeals and Special Projects Corporate Position located in beautiful ... to coding guidelines. REQUIREMENTS: Strong clinical background along with leadership... more

Oct 13 Sacramento Quality Improvement & Facility Site Review RN or LCSW – Managed Care Carenational Healthcare Services Sacramento, CA

The specialist will assess provider performance and quality of care through clinical case ... summaries and recommendations. Performs clinical review related to Grievances, Appeals,... more

Oct 13 Utilization Management Specialist - Full Time (80 hours) - FSS - Highline Region (0000) Alegent Creighton Burien, WA

Facilitates the achievement of consistent clinical outcomes by concurrently assessing ... advisor. Researches and prepares written appeals in response to third party payor... more

Oct 11 Behavioral Health Utilization Management Specialist Meridian Health Plan Michigan

for utilization, authorization, denials and appeals auditing, compliance and reporting ... **** * Implement new/revised processes among clinical utilization management staff... more

Oct 11 Denials Specialist Meridian Health Plan Michigan

for Utilization Management and appeals. *Open Positions:* 1 *Position ... To:* Manager of Clinical Services *Position Title:* Denials Specialist *Located In:*... more

Oct 11 Appeals Analyst Mindlance Richmond, VA

DUTIES AND RESPONSIBILITIES: Audits work of appeals specialists. Identifies training ... correspondence to appellant on clinical appeals. Researches and compiles... more

Oct 10 Clinical Utilization Management Specialist Job Blue Cross and Blue Shield of Minnesota Saint Paul, MN

Clinical Utilization Management Specialist (Job Number:11172) Description Summary: This ... departments. Accountabilities: 1. Applies clinical experience, health plan benefit... more

Oct 08 Finance Case Manager Job Cleveland Clinic Foundation Independence, OH

activities within the Payer Audit and Clinical Denial Management department. ... denial appeal follow-up; analyzes provided clinical documentation, criteria application... more

Oct 06 HEDIS/Quality Auditor Caremore Health Plan Cerritos, CA

projects to improve health plan quality. Appeals and Grievances, HEDIS, CAHPS, HOS, ... or regulatory purposes. Monitors health plan clinical activities and identifies... more

Oct 04 Physician Documentation Review Specialist Community Health Systems Franklin, TN

Title: Physician Documentation Review Specialist Location: TN-Franklin (Nashville Region) ... seeks a two Physician Documentation Review Specialist for its Franklin, TN,... more

Oct 02 Physician Documentation Review Specialist Community Health Systems Professional Services Franklin, TN

seeks a two Physician Documentation Review Specialist for its Franklin, TN, ... and ability to evaluate and summarize clinical records to support successful... more

Oct 01 Coding Compliance Specialist Center For Diagnostic Imaging Saint Louis Park, MN

response to payor denials and appeals COMPETENCIES (KNOWLEDGE, SKILLS AND ABILITIES) ... medical records and create audit/review reports that assist management, providers and... more

Oct 01 Physician Documentation Review Specialist CHS Corporate Franklin, TN

seeks a two Physician Documentation Review Specialist for its Franklin, TN, ... specific education and training based on audit findings. Works within the CHS... more

Sep 30 Assistant Vice President of Finance - Inova Medical Group P. A. R. Associates Fairfax, VA

throughout northern Virginia, including clinical, emergency department and ... the specialists. Specialists will support clinical integration, volume growth of... more

Sep 29 Auditor/Educator, Health Information Mngt. Pomona Valley Hospital Medical Center Pomona, CA

Interacts with clinical staff/CDI for the purpose of documentation improvement and clarifi ... Responsible for RAC audit finding, appeals and re-billing in coordination with... more

Sep 27 Pharmacy Specialist Villagecare New York City, NY

oversight delegated functions related to clinical and quality programs, provider ... clinical review and support of Part D appeals and grievances in compliance with... more

Sep 27 Medical Coding Supervisor New York City, NY

physiological and medical terminology. Audit both outpatient and inpatient medical ... and education. Requires Certified Coding Specialist (CCS) or Certified Professional... more

Sep 26 Project Coordinator (School of Nursing) George Mason University Fairfax, VA

This individual will manage the on-site clinical activities and coordinate community ... patient individual and group sessions; * Audit and assist in resolving deficiencies... more

Sep 26 Medical Coding Operations Supervisor Pittsburgh, PA

physiological and medical terminology. Audit both outpatient and inpatient medical ... and education. Requires Certified Coding Specialist (CCS) or Certified Professional... more

Sep 19 Clinical Documentation Specialist-$8000 SIGN-ON BONUS AVAILABLE!!! Boca Raton Regional Hospital Boca Raton, FL

the overall quality and completeness of clinical documentation. Position Expectations ... governmental and non-governmental payer appeals in support of DRG validation and... more

Sep 16 Program Administration Specialist II - Project Coordinator (School of Nursing) George Mason University Fairfax, VA

This individual will manage the on-site clinical activities and coordinate community ... patient individual and group sessions; Audit and assist in resolving deficiencies... more

Sep 14 Senior Specialist Performance Improvement Sharp Healthcare San Diego, CA

Specialist manages peer review activities, member grievances, and member appeals processes ... Senior Specialist-Performance Improvement Specialist, RN, Quality, Quality Management,... more

Sep 11 Physician Coding Review Specialist Community Health Systems Franklin, TN

Title: Physician Coding Review Specialist Location: TN-Franklin (Nashville Region) Job ... Corporation seeks a Physician Coding Review Specialist for its Franklin, TN,... more

Sep 10 Manager, Clinical Documentation Improvement -$8000 SIGN-ON BONUS AVAILABLE!!! Boca Raton Regional Hospital Boca Raton, FL

Improvement POSITION SUMMARY: The Clinical Documentation Improvement (CDI) ... to ensure accurate and timely clinical documentation in the medical record... more

Sep 08 Physician Advisor, Cobb/Windy Hill Hospitals WellStar Health System Marietta, GA

The Physician Advisor conducts clinical review on cases referred by Care Coordination/Case ... experience. Management experience with focus on clinical acumen, business, strategic... more

Sep 07 Audit Support Specialist Medimpact San Diego, CA

**Position Summary:** The Audit Support Specialist serves as the primary subject matter ... Government Program Specialist, Clinical Program, Drug Information, Prior... more

Sep 04 Customer Care Specialist Magellan Health Services Maryland Heights, MO

* Supports Appeals triage and claims appeals. * Observes and tracks authorization ... of our offerings, depth of expertise, clinical excellence and smart, talented... more

Sep 02 Reimbursement Executive Search Solutions Chicago, IL

Accounts Receivable Executive with clinical reimbursement, Private Pay, HMO, ... We require an articulate, professional A/R Specialist with exceptional communication and i... more

Sep 02 Accounts Receivable Director Executive Search Solutions Chicago, IL

Accounts Receivable Executive with clinical reimbursement, Private Pay, HMO, ... We require an articulate, professional A/R Specialist with exceptional communication and i... more

Sep 02 Business Office Manager Executive Search Solutions Chicago, IL

Accounts Receivable Executive with clinical reimbursement, Private Pay, HMO, ... We require an articulate, professional A/R Specialist with exceptional communication and i... more

Aug 28 Manager of Clinical Standards Prostep Rehabilitation Milwaukee, WI

Coordinate with Clinical Operations and Clinical Reimbursement for joint presentations/fol ... Assist with denials process/preparation for appeals a... more

Aug 28 Cert Coding Specialist Surgical Dupage Medical Group Illinois

* Serves as a resource to providers and clinical staff on coding questions and ... patients, physicians, and other clinical and clerical personnel * May require periodic... more

Aug 28 Clinical Recovery Audit Specialist II Carolinas Healthcare System Charlotte, NC

Performs chart reviews and clinical appeals as related to medical necessity, ... of hospital nursing experience in various clinical areas. **Posting Notes:** Not... more

Aug 27 Internal Medicine - Physician Concentra Addison, TX

Apply today with interest!Relying on clinical background, reviews health claims ... pediatrics jobs, internal medicine geriatrics jobs, internal medicine specialist... more

Aug 27 Claims Resolution Specialist Clinical Specialties Brecksville, OH

and audit purposes. 3. Conducts weekly audit of MAS 90 aging, making necessary ... requirements, as they relate to Clinical Specialties' providers. 6. Assists... more

Aug 26 Rehab Project Coordinator /Medical Record Reviewer Five Star Quality Care Newton, MA

in Chart reviews and Medicare audits and appeals. Strong clinical and teaching skills ... with the Medicare Specialist, Clinical Rehab Manager and Medicare Review... more

Aug 18 Patient Accounts Specialist Mednax Sunrise, FL

and pediatric intensivists to provide a clinical care continuum. We have an ... The Patient Account Specialist may work collection reports and correspondence, audit accou... more

Aug 18 Patient Accounts Specialist Pediatrix Sunrise, FL

Office in Sunrise.The Patient Account Specialist is responsible for covering for ... The Patient Account Specialist may work collection reports and correspondence, audit accou... more

Aug 15 Home Health Quality Assurance Manager Gentiva Health Services Union, SC

certification, and accreditation results. Audit charts for clinical oversight and ... as necessary. Collaborate with the Clinical Leadership and clinical associate... more

Aug 12 Physician - Administration - Management Baptist Health South Florida Jacksonville, FL

5. Appeals Management- Works with Finance, Audit Services, Patient Financial Services, ... license • At least 5 years of clinical practice experience Facility Description As a... more

Aug 11 Coding Specialist II - Central Billing Dupage Medical Group Illinois

* Serves as a resource to providers and clinical staff on coding questions and documentation requirements/guidelines. * Monitors services performed to assure all encounters are... more

Aug 09 Physician Advisor opportunity in beautiful Baptist Medical Center Florida

Appeals Management- Works with Finance, Audit Services, Patient Financial Services, and ... medical license At least 5 years of clinical practice experience Facility Description... more

Jul 28 REVENUE CYCLE MANAGEMENT SPECIALIST University of Washington Seattle, WA

The Revenue Cycle Management Specialist provides technical expertise, consultation ... claims, including coordination of appeals and justification of revenue allowance. more

Jun 30 Physician Coding Review Specialist CHS Corporate Franklin, TN

Corporation seeks a Physician Coding Review Specialist for its Franklin, TN, ... and ability to evaluate and summarize clinical records to support successful appeal... more

Jun 30 Physician Pro Fee Coding Specialist 1 CHS Corporate Franklin, TN

Corporation seeks a Physician Pro Fee Coding Specialist 1 for its Franklin, TN, ... and ability to evaluate and summarize clinical records to support successful appeal... more

Jun 26 Appeals and Denials Specialist (Corporate Services Building - Third Party Audit - FT/Days) St. John Health System Michigan

*Title: Appeals and Denials Specialist (Corporate Services Building - Third Party Audit - ... Corporate Services Building *Appeals and Denials Specialist (Corporate... more

Jun 13 Physician Pro Fee Coding Specialist II Community Health Systems Franklin, TN

Title: Physician Pro Fee Coding Specialist II Location: TN-Franklin (Nashville Region) Job ... and ability to evaluate and summarize clinical records to support successful appeal... more

Jun 13 Physician Pro Fee Coding Specialist 1 Community Health Systems Franklin, TN

Title: Physician Pro Fee Coding Specialist 1 Location: TN-Franklin (Nashville Region) Job ... and ability to evaluate and summarize clinical records to support successful... more

Jun 06 Physician Pro Fee Coding Specialist 1 Community Health Systems Professional Services Franklin, TN

Corporation seeks a Physician Pro Fee Coding Specialist 1 for its Franklin, TN, ... and ability to evaluate and summarize clinical records to support successful... more

Jun 06 Physician Pro Fee Coding Specialist II Community Health Systems Professional Services Franklin, TN

and ability to evaluate and summarize clinical records to support successful appeal Reasoning Ability: • Proven analytical and organizational ability. • Ability to define... more

May 30 Physician Coding Review Specialist Community Health Systems Professional Services Franklin, TN

Corporation seeks a Physician Coding Review Specialist for its Franklin, TN, ... and ability to evaluate and summarize clinical records to support successful appeal... more

May 29 Coding Data Specialist Coordinator Beaumont Hospitals Royal Oak, MI

The Inpatient Coding Data Specialist Coordinator is responsible for training new coding ... and ICD 10 . Also assists physicians and clinical staff on coding process and... more

May 20 Clinical Documentation Specialist Boca Raton Community Hospital Boca Raton, FL

the overall quality and completeness of clinical documentation. ***Position ... governmental and non-governmental payer appeals in support of DRG validation and... more

May 20 Coding Supervisor Physcian Practice-Coding - 126979 Banner Health Greeley, CO

Works with physicians to improve clinical documentation and accurate reimbursement. ... education. Requires Certified Coding Specialist (CCS) or Certified Professional Coder... more

May 07 CHIEF PHYSICIAN AND SURGEON, CORRECTIONAL FACILITY State Personnel Board San Bernardino, CA

dealing with clinical issues, including clinical guidelines for disease managment, ... institution providers performed by clinical institutional supervisors and/or managers as... more

Apr 30 Cert Coding Specialist (Surg) II Dupage Medical Group Illinois

· Serves as a resource to providers and clinical staff on coding questions and documentation requirements/guidelines. · Monitors services performed to assure all encounters are... more

Mar 18 Medical Director Laser Spine Institute Tampa, FL

professional standards. * Provides clinical expertise needed to effectively and ... regarding provider appeals. * Ensures compliance with federal, state, and... more

Mar 16 Appeals Specialist Magellan Health Services Florida

Administrative and clinical oversight of appeals processes and staff of department. ... case load. ��� Administers appeals department.��� Provides administrative and clinical... more

Jan 09 Medical Records Cookeville Regional Medical Center Cookeville, TN

coding-related appeals and coordinate other appeals when a payer or their subcontractor ... Information Technician, Certified Coding Specialist, eligibility for... more

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