- Fallon Health (Worcester, MA)
- …at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn. **Responsibilities** The Chart Review Specialist primary responsibility is to review , ... charts for the purpose of validating regulatory Risk Adjustment scores. The Chart Review Specialist will collect diagnostic details and documentation… more
- Providence (Beaverton, OR)
- …them._** **Providence Health Plan is calling an** HCC Risk Adjustment QA Auditor: Medicare Advantage & ACA **who will:** + Perform internal coding audits of ... Hhierarchical Condition category (HCC) coding review for Risk Adjustment staff, contractors, and vendors +...audit findings and trends + Perform HCC abstract reviews, chart reviews, and other reviews as assigned **_Providence Health… more
- Behavioral Center of Michigan (Warren, MI)
- …data and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart and records clinical information ... Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex… more
- Trinity Health (Columbus, OH)
- **Employment Type:** Part time **Shift:** **Description:** **Utilization Review RN, Case Management** **Why Mount Carmel?** With five hospitals ... (https://www.mcmg.mountcarmelhealth.com/) , a college of nursing (https://www.mccn.edu/) , a Medicare Advantage plan (https://www.medigold.com/) , and extensive outreach and… more
- CommonSpirit Health Mountain Region (Durango, CO)
- …leaders who care about your success. Assist with training and coordinating clinical review and quality assurance. Lead and review the appropriateness of clinical ... care and documentation practices related to patients/residents. Review and evaluate quality data to determine areas needing improvement. Review patient… more
- Actalent (Chicago, IL)
- Job Title: HEDIS Review SpecialistJob Description - Will be calling out to providers and doctors' offices to retrieve medical information and ask any follow-up ... Will be part of the Quality Department for the Medicare Team, working alongside full-time members with audits and...part of the HEDIS team during the Jan-May season. Review medical records from all 5 states. Abstracting 6… more
- HonorHealth (Scottsdale, AZ)
- …quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and ... Responsible for coordinating and conducting medical necessity reviews for all Medicare , AHCCCS, Self-pay, and all other payers, upon admission and concurrently… more
- Sharp HealthCare (La Mesa, CA)
- …coverage through MCA for SRS/SCMG and MPV (or Portal) for potential Medicare or Medi-Cal.Use Coordination of Benefits (COB) standards to prioritize billing order ... of insurance plans. Medicare patients - Medicare Secondary Payer (MSP)...medical records and facilitate transfers from/to outside facilities.Create patient chart for physician and organize charts for the HIM… more
- Sanford Health (SD)
- …guidance and support to all operating segments across Sanford. Responsible to review Medicare /Medicaid documentation to assist nursing centers in completing ... minimum data set (MDS) documentation to assure appropriate levels of Medicare and/or Medicaid reimbursement. Works with executive leadership, administrators, and… more
- Corewell Health (Stevensville, MI)
- …of last day of Medicare A coverage. + Performs audits and quality review duties as assigned by Manager. Monitors accuracy of MDS items completed by other ... Ridge is a 111-bed Skilled Nursing Facility that is Medicare and Medicaid Certified with 33 private rooms and... and Medicaid requirements. Essential Functions + Reviews nursing chart on resident information and performs evaluations as needed… more
- Mount Sinai Health System (New York, NY)
- …registered; Completes the central log assuring all fields are complete + Completes Medicare Payor Questionnaire for all Medicare patients + Collects visit fees ... Patient Registration log + Makes appropriate copies of complete chart and stores in dedicated locations + Disburses ... + Gives attending physician walk out charts for review twice daily **About Us** **Strength Through Diversity** The… more
- St. Luke's University Health Network (Hamburg, PA)
- …education of network policy on Patient Identification including Mark for Merge, Chart Corrections, and Patient Look-Up. + Responsible for the patient registration ... related to registration. Can require contacting provider office, reviewing patient medical chart for diagnosis and medical necessity information. + Required to cross… more
- University of Colorado (Aurora, CO)
- …in-box continually during clinic hours and over the lunch hour. + Refill medications, review chart in detail, check PDMP for controlled substances. Task to front ... hours and over the lunch hour. + Refill medications, review chart in detail, check PDMP for...to obtain full prescriptive authority and DEA registration. + Medicare /Medicaid credentials. + Unrestricted DEA license and current CPR… more
- Penn Medicine (Philadelphia, PA)
- …CDI system of record to truthfully demonstrate current state discovered via chart review , discovery of qualities needing further provider clarification, ... Physician or designee requesting appropriate documentation + Ongoing concurrent chart review , identification of complications and co-morbidities, collaboration… more
- Fresenius Medical Center (Newport Beach, CA)
- …(supply inventory for order, Kt/V collection, bringing meds to clinic visit for review ) + Prepare initial patient chart for admission. Complies and maintains ... the designated clinical application in an accurate and timely manner. + Review treatment sheets for completeness, ensure nursing signatures are documented, and… more
- Fresenius Medical Center (Meridianville, AL)
- …(supply inventory for order, Kt/V collection, bringing meds to clinic visit for review ) + Prepare initial patient chart for admission. Complies and maintains ... the designated clinical application in an accurate and timely manner. + Review treatment sheets for completeness, ensure nursing signatures are documented, and… more
- Conviva (Jacksonville, FL)
- …medical care and quality for patients and monitors care using available data and chart reviews. . Assists in the coordination of patient services, including but not ... Leadership. . Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues....Medicine preferred . Active and unrestricted DEA license . Medicare Provider Number . Medicaid Provider Number . Minimum… more
- CenterWell (Durham, NC)
- …has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality primary ... for patients and monitors care using available data and chart reviews. + Assists in the coordination of patient...byClinical Leadership. + Meets with RMD about quality of care, review of outcome data,policy, procedure and records issues. +… more
- Conviva (New Braunfels, TX)
- …medical care and quality for patients and monitors care using available data and chart reviews. . Assists in the coordination of patient services, including but not ... Leadership. . Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues....required to be screened for TB **Preferred Qualifications:** + Medicare Provider Number + Medicaid Provider Number + Minimum… more
- Conviva (Tampa, FL)
- …and represent the clinical perspective of the market. + Assist in Ongoing Chart Review monitoring. + Assist with recruitment and interviewing as requested. ... screened for TB. **Preferred Qualifications** + Active and unrestricted DEA license + Medicare Provider Number + Medicaid Provider Number + Minimum of three to five… more