Clinical Appeals Audit Specialist jobs

  Subscribe to RSS Feed
Posted Job Title Company Location

Looking to hire? Post your job today!

Featured Job Postings from the Web
Dec 17 RN Appeals Specialist(275895) Kaiser Permanente Oakland, CA

Description The Clinical Appeals Coordinator/Specialist reviews communications from member ... additional information is needed. works with Appeals Specialist as a resource for... more

Nov 27 Floating/Traveling RN Director of Clinical Management Gentiva Health Services Columbus, OH

to the Area Education or Area Clinical Specialist when task is completed. * Serves ... clinical director, clinical administrator, clinical supervisor, patient care manager,... more

Nov 27 Hospice Clinical Manager Specialist Gentiva Health Services New York City, NY

every single day. As aClinical Manager Specialist for our Hospice Division, you ... * Oversee maintenance of patient/client clinical records, statistics, reports and records... more

Nov 26 Certified Surgical Coding Specialist - Central Billing Dupage Medical Group Downers Grove, IL

Job Description Certified Surgical Coding Specialist-Central Billing Full time/Days Job Su ... and other clinical and clerical personnel DISCLAIMER: The above statements in... 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

More Job Postings from the Web
Dec 17 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

Dec 15 Payment Recoveries Specialist Chicago Health System Westmont, IL

claim overpayments. This includes review of appeals and reporting of recovery activity relating to claim overpayments. Oversees and maintains system related software specific to... more

Dec 13 Grievance Team Lead Meridian Health Plan Detroit, MI

Analyzes and identifies trends for appeals * Coordinates with the Quality ... to grievances * Prepares, with the grievance specialist/coordinator, each second level... more

Dec 12 PRN Intake Coordinator - 25-29 hours(298136) Kaiser Permanente Atlanta, GA

notification only requests (no clinical review), utilizing established ... ACD queue line experience preferred. Clinical background preferred. Primary... more

Dec 12 Claims Specialist, Senior Healthcare Partners Torrance, CA

for you. We are currently seeking aClaims Specialist, Senior: Responsiblefor ... professional and facility medical claims, appeals and prepayment audits. Answers... more

Dec 11 Business Operations Specialist UnitedHealth Group Irvine, CA

Plan eligibility and benefits, opening of clinical cases with preliminary information, ... faxes to clinical records, entry of Clinical Service authorizations for medically... more

Dec 10 Timekeeper Providence Health & Services Everett, WA

include: One year experience as a Staffing Specialist. About the hospital you will serve. ... Distinguished Hospital Award for Clinical Excellence four years in a row. Our new... more

Dec 10 Pharmacy Medication Therapy Management Coordinator Medwest Healthcare Recruiting Beaverton, OR

MTM services by developing and delivering clinical and educational interventions ... preferred Board Certified Pharmacotherapy Specialist BCPS and Certified Geriatric... more

Dec 10 Medical Director (M.D. or D.O) Spinesearch Tampa, FL

and accreditation requirements for clinical services. Provides current medical ... cancellations from medical screening, clinical evaluations, and consult centers. more

Dec 09 Medical Director (MD or DO) Spinesearch Tampa, FL

and accreditation requirements for clinical services. Provides current medical ... cancellations from medical screening, clinical evaluations, and consult centers. more

Dec 08 Manager, Health Information Management Knf&t Staffing Resources Boston, MA

information exchange) which impact various clinical, financial and operational areas ... and appeals submission. f) Documentation Specialist function as it relates to all... more

Dec 05 Customer Srvc Representative Philadelphia, PA

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

Dec 05 Nurse Manager of Case Management Mercy Health System Philadelphia, PA

audits to ensure targets are achieved. Clinical Documentation Improvement: Generate weekly ... reports from tracker tool to check the Clinical Documentation Specialists’ data and meets... more

Dec 04 DRG/Coding Quality Auditor Cook Children's Healthcare Fort Worth, TX

audit results for each coder and provides audit results to the Coding & CDI Educator ... (RHIT) required, Certified Coding Specialist (CCS) preferred. ICD-10-CM/PCS... more

Dec 04 Accounts Receivable Director Executive Search Solutions Chicago, IL

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

Dec 04 Hospice Clinical Manager Specialist New York City, NY

every single day.As a Clinical Manager Specialist for our Hospice Division, you ... - Oversee maintenance of patient/client clinical records, statistics, reports and records... more

Dec 04 Regulatory Auditor - Full Time St. Mary's Good Samaritan St Louis, MO

information into SSM’s web-based audit tracking tool. Through analysis and ... * Experience in clinical documentation improvement (ex.Clinical Documentation Specialist),... more

Dec 03 Payment Recoveries Specialist Conifer Health Solutions Westmont, IL

claim overpayments. This includes review of appeals and reporting of recovery activity ... Job : Non-Clinical/Administrative Primary Location : IL-Westmont Hospital/Facility : Chica... more

Dec 03 Coding Data Specialist Coordinator Beaumont Health System Troy, MI

Coding Data Specialist Coordinator supports inpatient coding staff. Trains new coding data ... ICD-9-CM/ICD 10. Also assist physicians and clinical staff on coding process and... more

Dec 03 Regulatory Auditor - Full Time SSM Health Care - St. Louis St Louis, MO

information into SSM’s web-based audit tracking tool. Through analysis and ... Experience in clinical documentation improvement (ex.Clinical Documentation Specialist), p... more

Nov 26 Behavioral Health Utilization Management Specialist Meridian Health Plan Detroit, MI

for utilization, authorization, denials and appeals auditing, compliance and reporting ... to perform monthly quality audits on clinical utilization management staff... more

Nov 25 Behavioral Health Utilization Management Specialist Commercial Operations Job Blue Cross and Blue Shield of Minnesota Saint Paul, MN

Behavioral Health Utilization Management Specialist Commercial Operations (Job ... (LMFT), Licensed Independent Clinical Social Worker (LICSW), Licensed Psychologist... more

Nov 25 Clinical Recovery Audit Specialist II Carolinas Healthcare System Charlotte, NC

Job Summary Performs chart reviews and clinical appeals as related to medical ... - Interfaces and collaborates with Clinical Care Management and Coding to ensure... more

Nov 22 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

Nov 22 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

Nov 19 Clinical Utilization Management Specialist Job Blue Cross and Blue Shield of Minnesota Saint Paul, MN

Clinical Utilization Management Specialist (Job Number:11312) Description Summary: This ... departments. Accountabilities: 1. Applies clinical experience, health plan benefit... more

Nov 18 Supervisor, Appeals and Grievances (Woodland HIlls) Health Net Woodland Hills, CA

evaluation tasks and counsels non-clinical Grievance and Appeals staff. * ... grievances, appeals, and provider disputes/appeals. * Regularly audits work of G&A... more

Nov 14 Manager of Audit and Appeal - Clinical and Vocational Services UnitedHealth Group South Portland, ME

with regard to quality assurance, appeals, clinical and vocational. They will ... Audit and Healthcare Manager, Manager of Audit and Healthcare, Manager of Audit and... more

Nov 12 Stockton CONTRACT RN Quality Improvement Nurse Specialist– Managed Care Carenational Healthcare Services French Camp, CA

summaries and recommendations. Performs clinical review related to Appeals and ... and provider complaints, grievances and appeals using considerable clinical judgment,... more

Nov 06 Certified Surgical Coding Specialist Dupage Medical Group Downers Grove, IL

Certified Surgical Coding Specialist: Central Billing Certified Surgical Coding Specialist ... * Serve as a resource for providers and clinical staff regarding coding questions and... more

Nov 06 VNA - Quality Review Clinical Informatics Specialist New Bedford, MA

: Under the general supervision of the Director, of Quality and Compliance or designee, perform diversified duties, including but not limited to responding to and tracking appeal... more

Nov 06 VNA - Quality Review Clinical Informatics Specialist Southcoast Jobmart New Bedford, MA

VNA - Quality Review Clinical Informatics Specialist Department: VNA - Performance/QA Schedule: Full-time Shift: Day shift Hours: 8:00 am - 4:30 pm Job Details: Under the general... more

Nov 05 VNA - Quality Review Clinical Informatics Specialist Southcoast Health System Fairhaven, MA

Under the general supervision of the Director, of Quality and Compliance or designee, perform diversified duties, including but not limited to responding to and tracking appeal... more

Nov 04 Director Of Health Information Management Workstaff USA Staffing Agency Akron, OH

Clinical/Electronic Health Record Maintenance: Works closely with Information Services, Me ... Certified Coding Specialist (CCS) and/or Certified Documentation Improvement Professional... more

Nov 02 Director Physician Appeals and Special Projects Community Health Systems Franklin, TN

appeal levels Maintain through the CHS RAC Appeals vendor, tracking of all appeals in ... and guideline changes related to audit and appeals process Maintains strict... more

Nov 01 C C A C Department of Workforce Services Ogden, UT

act as the corporate consultant for clinical Appeals and Audits for Intermountain ... Clinical Appeals Consultant will execute clinical audits of medical records on behalf... more

Oct 31 Grievances & Appeals Supervisor L.A. Care Health Plan Los Angeles, CA

responsibility for two Grievance & Appeals Specialists. Has Supervisory ... Med-Cal screening/eligibility experience Medicare experience in SFH, grievances & appeals... 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 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 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 Certified Medical Coding Specialist Ime Resources Redding, CA

to the Supervisor of any provider appeals and follow directions as given to ... effective and efficient utilization of clinical resources and supplies. * Perform... 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

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

arise. Works with physicians to improve clinical documentation and accurate ... 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 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 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 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 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 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/Coder 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 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

and Medicare audits and appeals. Strong clinical and teaching skills are required. ... * In collaboration with the Medicare Specialist, Clinical Rehab Manager and... 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 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 02 Revenue Cycle Management Specialist University of Washington Seattle, WA

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

May 20 Medical Director Laser Spine Institute Tampa, FL

accreditation requirements for clinical services. * Provides current medical expertise ... regarding provider appeals. * Ensures compliance with federal, state, and... 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

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 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

Jobs by Simply Hired