- Lyric (Newtown Square, PA)
- …experience as a nurse is a plus. + Current working knowledge of pre- payment editing and payment integrity . + Possess expertise at communication and ... to be recognized as 2025 Best in KLAS for Pre- Payment Accuracy and Integrity and is HI-TRUST...years or more relevant healthcare experience as a medical coder , medical claims processor medical auditor, clinical editing analyst,… more
- Stanford Health Care (Palo Alto, CA)
- …audits as requested. + Collaborates with RI CDM to optimize the integrity of the Chargemaster + Applies consistent and standardized compliance monitoring methodology ... anatomy and physiology and study of diseases + Knowledge of governmental payment practices for Medicare and MediCal + Working knowledge of commercial payer… more
- LA Care Health Plan (Los Angeles, CA)
- Payment Integrity Nurse Coder RN III Job Category: Clinical Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position Type: Full ... to support the safety net required to achieve that purpose. Job Summary The Payment Integrity Nurse Coder RN III is responsible for investigating,… more
- Highmark Health (Little Rock, AR)
- …and member satisfaction. The incumbent is responsible for the implementation of effective Payment Integrity strategies on a pre- payment and retrospective ... with established industry and corporate standards and are within the Payment Integrity Clinician's professional discipline.Effectively function in accordance… more
- Molina Healthcare (NE)
- …level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to ... **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal...criteria supporting all recommendations for denial or modification of payment decisions. + Serves as a clinical resource for… more
