Clinical Appeals Audit Specialist jobs

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Sep 17 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

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 10 Physician Clinical Documentation Specialist Franciscan Alliance Hammond, IN

reviews for comparative analysis of Clinical Documentation Improvement Specialist ... Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement... 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
Oct 01 Hospice Clinical Manager Specialist Gentiva Phoenix, AZ

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

Sep 30 Physician Documentation Review Specialist Community Health Systems Professional Services 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 Project Coordinator (School of Nursing) George Mason University Fairfax, VA

<br /><br /> <b>Responsibilities: </b> This individual will manage the on-site clinical ac ... patient individual and group sessions; * Audit and assist in resolving deficiencies... 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 ... <li>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 29 Clinical Utilization Management Specialist Job Blue Cross and Blue Shield of Minnesota Saint Paul, MN

Clinical Utilization Management Specialist (Job Number:10866) Description Summary: This ... departments. Accountabilities: 1. Applies clinical experience, health plan benefit... 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 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 24 Managed Care Grievance Appeal Specialist Denver Health & Hospital Authority Denver, CO

related to pharmacy benefit based on clinical review criteria. Prepares denial ... regarding PAR determination outcomes. Clinical and technical knowledge is utilized... more

Sep 23 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

Sep 23 Project Specialist Catholic Health Initiatives Federal Way, WA

Facilitate the spread of excellent clinical and service quality for all members. ... dashboard updates. * Supports reporting and audit for Medicare data validation. *... more

Sep 22 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

Sep 22 Registered Nurse - Clinical Specialist Job Yoh Los Angeles, CA

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

Sep 22 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

Sep 20 Appeals Coordinator Specialist Aria Health Philadelphia, PA

Appeals Coordinator Specialist Department: Care Management (TC [1A961]) Schedule: Regular ... Experience The Appeals Coordinator Specialist is responsible for collecting,... 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 18 Project Specialist Alegent Creighton Federal Way, WA

Facilitate the spread of excellent clinical and service quality for all members. ... dashboard updates. Supports reporting and audit for Medicare data validation. Provides... more

Sep 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

Sep 17 Rehab Project Coordinator / Medical Record Reviewer Five Star Rehabilitation & Wellness New Town, MA

and Medicare audits and appeals. Strong clinical and teaching skills are required. ... * In collaboration with the Medicare Specialist, Clinical Rehab Manager and... more

Sep 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

Sep 17 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

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 16 RegisteredNurse-MedicalNecessityReviewSpecialist-UtilizationManagement-NewOrleans Louisiana Hospital Association New Orleans, LA

Medical Necessity Review Specialist applies clinical expertise, case management, ... Duties: 1. Performs clinical review in the audit for Medical Necessity 2. Provides... more

Sep 15 Director of Compliance Memory Training Centers of America Forest Hills, NY

(i.e., Adjudication, Coverage Determination, Appeals, Grievance, PDEs, and Clinical) to ... impacting businesses Serves as appeals specialist, coordinating, tracking, and... more

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

Physician Coding Review Specialist-1445007 ## Description Community Health Systems ... seeks a **Physician Coding Review Specialist** for its Franklin, TN,... more

Sep 10 RAC & FORMS SPECIALIST– Durango, CO Temporary Part time Position (June–Nov) Job Centura Health Durango, CO

3), timely coordination of appeals and associated deadlines. Assists Medical Record ... Work Group.As Forms Management Specialist, using the Forms Management Policy as a... 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 10 Physician Advisor, Cobb/Windy Hill Hospitals WellStar Health System Marietta, GA

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

Sep 09 RAC & FORMS SPECIALIST- Durango, CO Temporary Part time Position (June-Nov) Job Centura Health Durango, CO

inforamtion, 3), timely coordination of appeals and associated deadlines. Assists Medical ... Coding Supervisor, Case Managers, Clinical Support Staff, in ensuring that RAC... 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 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

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

Aug 30 RAC & FORMS SPECIALIST Department of Workforce Services Durango, CO

for inforamtion,3),timely coordination of appeals and associated deadlines. Assists ... Manager,Coding Supervisor,Case Managers,Clinical Support Staff,in ensuring that RAC... 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 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 27 Medical Coding Supervisor Diskriter Detroit, MI

DRG’s and APC’s, and CDI (Clinical Documentation Improvement) and ... physiological and medical terminology. Audit both outpatient and inpatient medical... 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 27 Internal Medicine - Physician Concentra Addison, TX

Apply today with interest!Relying on clinical background, reviews health claims ... be in active medical practice to perform appeals JOB-RELATED EXPERIENCE:Post-graduate... 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 26 14-05 Director of Business Implementation Beacon Health Strategies Cypress, CA

clinical implementation work plan Develop Clinical Model Confirm Benefits Understand ... audit. Work closely with an implementation specialist and other SMEs to develop/gather... more

Aug 22 Clinical Appeals Specialist Valley Presbyterian Hospital Van Nuys, CA

Clinical Appeals Specialist Department: Patient Financial Services Schedule: Full Time ... Job Details: JOB SUMMARY: The Clinical Appeals Specialist is responsible for... more

Aug 21 Clinical Appeals Specialist (837310) Valley Presbyterian Hospital Van Nuys, CA

JOB SUMMARY: The Clinical Appeals Specialist is responsible for managing medical denials ... for follow up on clinical denials and timely appeals submission. 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 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 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, ... medical license At least 5 years of clinical practice experience Facility... more

Aug 06 Hospice Clinical Manager Specialist Gentiva Health Services Phoenix, AZ

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

Aug 05 Coding Supervisor Asante Medford, OR

with Revenue Cycle leadership and other clinical department staff to continuously ... (AHIMA) is required: Certified Coding Specialist (CCS); or Registered Health... more

Jul 31 Utilization Review Specialist TMP Worldwide Brooklyn, NY

Nurse - UTILIZATION REVIEW SPECIALIST</strong></p><p><strong>Brooklyn, ... Clinical documentation enhancement guidelines will be utilized.</p><p><strong>Responsibili... more

Jul 31 CM Clinical Operations Coordinator Partners Healthcare System Boston, MA

The CMCOCs work closely with the Case Manager Specialist on educational/training component ... audits and processing Federal payer denials/appeals audits. Responsible for routine... more

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

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

Jul 24 Manager Coding, HIM Medical Records WPAHS Allegheny Health Network Pittsburgh, PA

staff regarding coding compliance and clinical documentation. * Administers the ... Technician (RHIT) or Certified Coding Specialist (CCS) preferred *Allegheny Health... more

Jul 24 Chief Medical Director Centene Tacoma, WA

policies and procedures. * Serves as clinical advisor to and educator of medical ... authorizations, concurrent review and appeals/retrospective review. * Responsible... more

Jul 24 Chief Medical Director Sunflower State Health Plan Tacoma, WA

attendant policies and procedures. Serves as clinical advisor to and educator of medical ... authorizations, concurrent review and appeals/retrospective review. Responsible for... more

Jul 23 Chief Medical Director Acariahealth Tacoma, WA

attendant policies and procedures. Serves as clinical advisor to and educator of medical ... authorizations, concurrent review and appeals/retrospective review. Responsible for... more

Jul 22 Supervisor, Appeals and Grievances (Woodland Hills) Health Net Woodland Hills, CA

evaluation tasks and counsels non-clinical Grievance and Appeals staff. Orients ... grievances, appeals, and provider disputes/appeals. Regularly audits work of G&A... 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 25 Appeals and Denials Specialist (Corporate Services Building - Third Party Audit - FT/Days) St. John Providence Health System Michigan

of a third party audit. The denied cases may include medical necessity for one-day ... provides clinical support to the outpatient charge auditors. This position serves also as... more

Jun 25 Manager Coding, HIM Medical Records WPAHS Allegheny Health Network – Corporate Pittsburgh, PA

regarding coding compliance and clinical documentation. Administers the computer system, ... Health Information Technician (RHIT) or Certified Coding Specialist (CCS)... more

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

Physician Pro Fee Coding Specialist 1-1445015 ## Description Community Health Systems ... seeks a **Physician Pro Fee Coding Specialist 1** for its Franklin, TN,... more

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

Physician Pro Fee Coding Specialist II-1445017##DescriptionCommunity Health Systems ... and ability to evaluate and summarize clinical records to support successful... more

May 30 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

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 30 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 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 29 Coding Supervisor Rogue Valley Medical Center Medford, OR

productivity and/or experience with writing appeals for coding denials ispreferred. ... (AHIMA) is required:Certified Coding Specialist (CCS);or Registered Health... more

May 20 Medical Director Laser Spine Institute Tampa, FL

accreditation requirements for clinical services.</li><li>Provides current medical ... Reviews and makes determinations regarding provider appeals.</li><li>Ensures compliance wi... 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 20 Clinical Documentation Specialist Boca Raton Community Hospital Boca Raton, FL

the overall quality and completeness of clinical documentation.***Position ... (RHIT), or Certified Coding Specialist (CCS).OR* Current Florida RN... 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... 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

Feb 06 Denials Specialist Meridian Health Plan Michigan

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

Jan 24 Coding Compliance Consultant, Full time, Days, Health Info, INTEGRIS, OKC Integris Health Oklahoma City, OK

Compliance Consultant analyzes relevant clinical and demographic information from the ... Reports to the System Manager Clinical Coding. Required Physical Demands... more

Jan 09 Medical Records Cookeville Regional Medical Center Cookeville, TN

coding-related appeals and coordinate other appeals when a payer or their subcontractor ... Regional Medical Center. Coding Specialist Apply Type FT Hours... more

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