- Elevance Health (Atlanta, GA)
- ** Nurse Auditor Senior - Payment Integrity... policy guidelines strongly preferred + BA/BS preferred + Medical claims review with prior health care ... formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Nurse Audit Senior** will be responsible… more
- Saint Francis Health System (Tulsa, OK)
- …**to login and apply.** Full Time Days Job Summary: The Compliance Nurse Auditor assists with and supports the compliance program activities ... within Saint Francis Health System (SFHS). This role supports clinical coding and...and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 3 years of healthcare… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and compliance functions necessary to effect accurate and complete ... reimbursement to the health system from third party payers. Reports to the...regulations and trends in denials of services due to medical necessity or appropriateness of services. + Conducts compliance,… more
- Banner Health (AZ)
- …to employment settings by including remote and hybrid opportunities. As a **Licensed Practical Nurse (LPN)** for **Banner Health Plans** , you will be an ... integral part of the ** Health Plan Medical Management Team** . This assignment-based role focuses on independent chart review and clinical assessment. **Key… more
- Northwell Health (Glen Cove, NY)
- …to the assignment can be substantiated by the documentation in the Medical Record. Job Responsibility 1.Leverages clinical expertise to identify and validate DRG ... and related experience. 2.Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed. 3.… more
- Stanford Health Care (Palo Alto, CA)
- …Stanford Health Care job.** **A Brief Overview** The Charge Auditor performs auditing activities, including complex cases that require extensive research, ... capture workflows and CDM + Knowledge of DRG/APC reimbursement + Knowledge of health information systems for computer application to medical records + Knowledge… more
- Elevance Health (Los Angeles, CA)
- …is granted as required by law. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to ensure ... **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This...an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in… more
- Providence (CA)
- …we know that to inspire and retain the best people, we must empower them._** **Providence Health Plan is calling a Coding Quality Auditor , HEDIS who will:** + Be ... + Utah **Required Qualification:** + Technical certification/licensure in the area of Medical Assistant, Certified Nurse Assistant, or Licensed Practical … more
- UNC Health Care (Chapel Hill, NC)
- …inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve. Summary: This positon ... the state to train and shadow round with Clinical Documentation Specialists. The CDS auditor provides elbow to elbow support during training and education as well as… more
- Trinity Health (Fresno, CA)
- …Reporting to the Nurse Manager*, Cath Lab, the Nurse Auditor performs thorough chart review of Electronic Medical Records (EMR) documentation for ... education is required. 2. Current licensure as a Registered Nurse (RN) with the state of California is required....local law. Our Commitment to Diversity and Inclusion Trinity Health is a family of 115,000 colleagues and nearly… more
- Baylor Scott & White Health (Dallas, TX)
- …work experience. + At least (2) two years of relevant work experience. + Registered Nurse License. As a health care system committed to improving the health ... **About Us** Here at Baylor Scott & White Health we promote the well-being of all individuals,...level **Job Summary** In this job, as a Clinical Auditor RN, you'll perform charge capture accuracy audits by… more
- US Tech Solutions (Newark, NJ)
- …months contract with potential extends or Convert** **Job Description:** + The HEDIS Nurse Auditor is responsible for conducting quality audits related to state ... experience, preferably in the healthcare industry. + **Active New Jersey Registered Nurse (RN) License required.** **Skills:** + Knowledge of managed care principles… more
- Centene Corporation (Jefferson City, MO)
- …Mental Health Counselor (LMHC), Licensed Professional Counselor (LPC), Registered Nurse (RN), or Licensed Practical Nurse (LPN) Pay Range: $55,100.00 ... one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national… more
- Health Care Service Corporation (Tulsa, OK)
- …lowest cost setting reviews for services pre and post payment utilizing medical , contractual, legislative, policy, and other information to validate claims submitted ... billed. Conducting research; preparing documentation of findings and consulting with medical directors as needed. Coordination with all departments involved in each… more
- Molina Healthcare (Savannah, GA)
- …Credentialing Specialist (CCS), Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN), Certified Clinical Coder (CCD), Certified Medical Audit ... Committee for Quality Assurance (NCQA), and Molina requirements for the health plan(s) they support. Identifies risk and non-compliance, issues corrective action,… more
- University of Washington (Seattle, WA)
- …certified case manager, certified documentation specialist, certified coder, certified professional medical auditor + Previous experience working as an RN ... an outstanding opportunity for a **Clinical Appeals and Disputes Nurse .** **WORK SCHEDULE** + 100% FTE + 100% Remote...YOUR IMPACT GOES FURTHER** UW Medicine is Washington's only health system that includes a top-rated medical … more
- Actalent (Des Moines, IA)
- …requesting records, abstracting/overreading medical records, performing claims research, preparing medical records for the NCQA HEDIS Auditor , etc. Abstracts ... Data and Information Set (HEDIS) reporting for company's accredited products Conducts medical record reviews to support the annual reporting and responds to… more
- Baystate Health (Springfield, MA)
- …below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the ... employees. Minimum - Midpoint - Maximum $16.68 - $20.39 - $25.36 **Baystate Health , a nationally recognized leader in healthcare quality and safety, is looking for… more
- Baystate Health (Springfield, MA)
- …below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the ... employees. Minimum - Midpoint - Maximum $16.68 - $20.39 - $25.36 **Baystate Health , a nationally recognized leader in healthcare quality and safety, is looking for… more
- Baystate Health (Springfield, MA)
- …below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the ... employees. Minimum - Midpoint - Maximum $16.02 - $19.28 - $23.65 **Baystate Health , a nationally recognized leader in healthcare quality and safety, is looking for… more