Clinical Appeals Audit Specialist jobs

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Jul 23 Hospice Clinical Manager Specialist Gentiva Health Services Seattle, WA

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

Jul 11 Clinical Quality Review Nurse RN/LPN Confidential Search Solutions Chicago, IL

for facilitating Member and Provider Appeals. Clinical Quality Review Specialist ... Role requires experience in processing appeals- and/or clinical background... more

Jul 05 Utilization Management Specialist RN CB DLT Recruiting & Staffing Los Angeles, CA

of business programs. Utilizing considerable clinical judgment, independent analysis, ... in other assignment as needed (i.e. with the appeals process, internal audits, inter rater... more

More Job Postings from the Web
Jul 31 Senior Surgical Coding Specialist Stat Search Dedham, MA

for initiating and submitting timely appeals. Maintains continuing education ... Systems knowledge (IDX, EPIC, MediTech, E-Clinical) required. Coding Software knowledge... more

Jul 30 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 and ... Identify and report coding errors to Coding/Audit Lead and LPS Billing Director... more

Jul 30 Nurse - Appeals and Denials Healthcare Partners Covina, CA

will be responsible for assisting with clinical appeals review; review referral ... Experience with referrals and / or appeals including one year of recent clinical experienc... 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 27 Medical Director - M.D. or D.O. Laser Spine Institute Tampa, FL

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

Jul 24 Director of Compliance Audits and Appeals (RN) Archcare New York City, NY

plans to improve compliance. Serves as appeals specialist for nursing homes, ... internal monitoring systems of their clinical documentation and coding processes. more

Jul 24 UM Clinical Supervisor Univita Health Woodbury, MN

assure. RESPONSIBILITIES 1. Supervises UM Clinical staff and non-clinical support staff ... management process of the UM Clinical Specialist nurses including assessment,... 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 24 Registered Nurse - Medical Necessity Review Specialist - Utilization Management 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

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 REGULATORY NURSE SPECIALIST LEAD Louisiana Hospital Association New Orleans, LA

Job Summary The Lead Regulatory Nurse Specialist applies clinical expertise as well ... who are being reviewed via the regulatory audit process. The Nurse Specialist leads the... more

Jul 24 RN or LPN Appeals and Grievance Clinical Specialist Healthfirst New York City, NY

Overview: The Appeals & Grievances Clinical Specialist is responsible for receiving, ... appeals and grievances involving review of clinical information. Responsibilities:... more

Jul 24 Manager, Student Central DeVry Education Group Fresno, CA

you're a nursing educator, IT specialist, administrative professional, or student ... beyond the classroom and clinical environments. Chamberlain provides students with... more

Jul 23 Chief Medical Director Centene 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 Hospice Clinical Manager Specialist Gentiva Seattle, WA

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

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 23 Senior Specialist Performance Improvement Sharp Healthcare San Diego, CA

Specialist manages peer review activities, member grievances, and member appeals processes ... starting work. Keywords: 54621, Senior Specialist-Performance Improvement Specialist,... more

Jul 22 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

Jul 21 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

Jul 21 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

Jul 19 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

Jul 17 Chief Medical Director Coordinated Care 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 17 Chief Medical Director 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 16 Denial Management Representative CSI Companies Sarasota, FL

collaborates with the EMS Coding Specialist and Client Clinical Staff, to ... Refers clinical denials to the RCS Coding Specialist or other clinical staff, as... more

Jul 15 Data Quality Mgr - Downey(255263) Kaiser Permanente Bellflower, CA

AUDIT Oversight Committee (committee members include: MD Liaisons, Champions, Medical ... and/or Certified Coding Specialist - Physician (CCS-P). • Specialty coding certification... more

Jul 11 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

Jul 09 RAC & FORMS SPECIALIST- Durango, 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

Jul 08 Manager, Student Central Chamberlain College of Nursing Fresno, CA

regards to registration, academic appeals, withdrawals, program changes, etc., on ... reviews as assigned. Ensures audit compliance with University and government... more

Jul 03 DENTAL MEDICINE - COMPLIANCE SPECIALIST East Carolina University Greenville, NC

regulatory compliance requirements of SoDM's clinical, academic and research programs. ... HIPAA privacy complaints; Assist and conduct clinical trial billing audits, as necessary;... more

Jul 03 Dental Medicine - Compliance Specialist - 670001 Hs Sch Dentistry Admin East Carolina University Greenville, NC

regulatory compliance requirements of SoDM's clinical, academic and research programs. ... HIPAA privacy complaints; Assist and conduct clinical trial billing audits, as necessary;... more

Jul 02 Clinical Documentation Specialist-$8000 SIGN-ON BONUS AVAILABLE!!! Boca Raton Regional Hospital Boca Raton, FL

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

Jul 02 DENTAL MEDICINE - COMPLIANCE SPECIALIST View East Carolina University North Carolina

regulatory compliance requirements of SoDM's clinical, academic and research ... HIPAA privacy complaints; Assist and conduct clinical trial billing audits, as... 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 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

Jun 13 Physician Coding Review Specialist Community Health Systems Franklin, TN

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

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

Physician Pro Fee Coding Specialist 1-1445015##DescriptionCommunity Health Systems ... and ability to evaluate and summarize clinical records to support successful... more

Jun 13 Physical Therapist or Occupational Therapist Compliance Team Lead Fox Rehabilitation New Jersey

post requires effective communication with clinical staff of audit findings. In ... the Auditor will be able to complete appeals using their knowledge of clinical... more

Jun 12 MED REC CODING AUDITOR LD IP Inova Healthcare Falls Church, VA

for education of coding staff and Clinical Documentation Specialists related to ... RAC process; experience in DRG audit and appeals; physician concurrent and... more

Jun 09 Quality & UR Specialist McLaren Health Care Bay City, MI

audits and managing the denials/appeals process with third party payors. ... Nurse License * Five (5) years clinical experience * Five (5) years minimum... 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 Documentation Review Specialist Community Health Systems Professional Services Franklin, TN

education and training based on audit findings. * Works within the CHS compliance ... ability to evaluate and summarize clinical records to support successful... more

May 31 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

May 31 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 problems,... more

May 31 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... more

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

a Physician Coding Review Specialist for its Franklin, TN, headquarters��� HIIM team.��� ��� Summary:��� Reviews medical record documentation to select and sequence the... more

May 30 Physician Pro Fee Coding Specialist II Community Health Systems Professional Services Franklin, TN

Community Health Systems Professional Services Corporation is one of the leading operators ... data, establish facts, and draw valid conclusions. ��� Ability to interpret an... more

May 29 Coordinator / Utilization Review - Behavioral Health Randolph - FT Days Carolinas Healthcare System Charlotte, NC

clinical care guidelines as determined by Clinical Care Management.**Essential ... forms are forwarded to the Medical Audit and Appeals Department of CHS.* Performs... 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 Physician Documentation Review Specialist Community Health Systems Franklin, TN

Physician Documentation Review Specialist-1429142##DescriptionCommunity Health Systems, ... ability to evaluate and summarize clinical records to support successful... more

May 29 Coding Supervisor Rogue Valley Medical Center Medford, OR

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

May 28 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 personnelfor clinical documentation inefficiencies. more

May 20 Medical Director Laser Spine Institute Tampa, FL

accreditation requirements for clinical services.* Provides current medical expertise ... standards.* Provides clinical expertise needed to effectively and efficiently... more

May 20 Coding Supervisor Physcian Practice-Coding 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 Claims Specialist, Senior Healthcare Partners Torrance, CA

Claims Specialist, SeniorReq: 14341Department: IMCS ClaimsSchedule: Full TimeShift: ... professional and facility medical claims, appeals and prepayment audits. Answers... 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 20 Lead Coding Specialist Lake Forest Hospital Chicago, IL

Systems knowledge (IDX, EPIC, MediTech, E-Clinical) required - Coding Software ... required Shift 1 (Days) Expertise Non-Clinical-Administrative Education High School... more

May 14 DRG Analyst - Remote Chamberlin Edmonds Illinois

****$5,000 Sign-on bonus***** DRG Analyst, Audit and Recovery Services When you join ... for client account(s). • Audit medical records and assign International Coding... more

May 14 Director Therapeutic Recreation Mid-atlantic Health Care Philadelphia, PA

is provided. Records progress notes in the clinical record including subjective findings, objective symptoms, observations of behavior, interventions provided to resident and... more

May 14 DRG Analyst - Remote Emdeon Illinois

****$5,000 Sign-on bonus***** DRG Analyst, Audit and Recovery Services When you join ... for client account(s). • Audit medical records and assign International Coding... 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

Apr 25 Coding Supervisor Asante Health System Medford, OR

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

Apr 09 VP of Medical Affairs for HMO Health Plan/CMO Children's Medical Center Dallas, TX

concurrent review and appeals/retrospective review. * Actively participates ... knowledge and experience with clinical re-design, performance measurement and... more

Apr 08 Financial Service Specialist II - Grant Administrator of Post Awards George Mason University Fairfax, VA

contain all documentation needed to meet audit requirements; (5) assist in resolving a wide-variety of grants issues (such as conflict of interest, research misconduct, effort... more

Mar 26 UM Clinical Supervisor Univita Woodbury, MN

Supervises UM Clinical staff and non-clinical support staff including hiring and ... management process of the UM Clinical Specialist nurses including assessment,... 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

Mar 14 MEDICAL CODING DOCUMENTATION SPECIALIST Kennedy Krieger Institute Baltimore, MD

payor issues, documentation opportunities, clinical documentation requirements, and ... Administration, Nursing, or other clinical degree preferred. EXPERIENCE: *... more

Feb 20 Denial Management Specialist Umass Memorial Health Care Worcester, MA

Summary: Demonstrates successful appeal and audit responses to third-party payers ... for gathering, reporting, and analysis of clinical data. Excellent organizational and... 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 ... 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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