Clinical Appeals Audit Specialist jobs

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Nov 20 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 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

More Job Postings from the Web
Nov 28 Appeals Mgt Documentation Spec Mercy Oklahoma City, OK

The Appeals Management Documentation Specialists is responsible for performing a thorough ... EEO/AA/Minorities/Females/Disabled/Veterans *Appeals Mgt Documentation Spec* *Oklahoma Cit... more

Nov 27 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

Nov 27 Case Manager - Independence Job Independence, MO

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

Nov 26 Manager, Clinical Documentation Improvement -$8000 SIGN-ON BONUS AVAILABLE!!! Boca Raton Regional Hospital Boca Raton, FL

Improvement POSITION SUMMARY: The Clinical Documentation Improvement (CDI) ... staff and ancillary staff regarding clinical documentation Expected to write... more

Nov 26 Hospice Clinical Manager Specialist Gentiva Health Services Columbus, OH

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

Nov 26 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

Nov 26 Appeals Mgt Documentation Spec - Recovery Audit Program Mercy Health Systems of Northwest Arkansas Rogers, AR

Full-time Shift: Days Job Details: The Appeals Management Documentation Specialists ... those co-workers directly involved in the audit and appeal process. Minimum... 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 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

Nov 25 Customer Srvc Representative Coventry Health Care Philadelphia, PA

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

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

Behavioral Health Utilization Management Specialist Commercial Ops (Job Number:11324) ... (LMFT), Licensed Independent Clinical Social Worker (LICSW), Licensed Psychologist... more

Nov 25 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 ... manager, clinical director, clinical administrator, clinical supervisor, patient care... 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 21 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

Nov 21 Health Information Services Manager 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

Nov 21 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

Nov 19 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

Nov 19 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 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 Coding Supervisor Physcian Practice-Coding Banner Health Phoenix, AZ

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

Nov 17 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

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

notification only requests (no clinical review), utilizing established criteria & ... needed for clinical reviews. • Maintains excellent customer service &... 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 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 Coding Compliance Specialist Center For Diagnostic Imaging Saint Louis Park, MN

seeking a full-time, Coding Compliance Specialist to join our Corporate Office in ... to analyze medical records and create audit/review reports that assist management,... 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 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 04 DIR PHYSICIAN APPEALS / SPECIAL PROJECTS Vaco Technology Franklin, TN

and guideline changes related to audit and appeals process * Maintains strict ... to audit and appeals process • Maintains strict confidentiality of provider... more

Nov 04 Certified Coding Specialist - Surgical Dupage Medical Group Downers Grove, IL

Serves as a resource to providers and clinical staff on coding questions and ... and other clinical and clerical personnel DISCLAIMER: The above statements in... 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 Corp Clinical Appeals Cnsltnt Intermountain Healthcare 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

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 29 Prior Authorization/Rules Service Specialist Medimpact San Diego, CA

teams, Clinical Program Managers (CPMs), Clinical Specialists, and Drug Information ... functions within the department such as audit and appeals support, prepare documents... 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 16 Quality Improvement Specialist Catholic Health Initiatives Federal Way, WA

Facilitate the spread of excellent clinical and service quality for all ... are met. Support the Grievances and Appeals process as needed. Builds provider... 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 13 Certified Medical Billing/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 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 11 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 08 Case Manager - Independence 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 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 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 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 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 05 Audit Support Specialist Medimpact San Diego, CA

based policies and procedures. The Audit Support Specialist will work with the ... Government Program Specialist, Clinical Program, Drug Information, Prior... 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 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 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 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 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 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 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

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

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 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 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 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 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

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 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

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 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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