- The Cigna Group (Philadelphia, PA)
- **Job Summary:** The Medicare Coding Quality Review Audit Manager is responsible for day-to-day oversight of the Risk Adjustment coding quality ... is broadened. + Plans, develops, implements, and monitors Cigna's Medicare 's QA of coding projects. + Monitors...as designed + Works closely with Quality Review Audit Advisor to ensure Risk Adjustment coding… more
- Highmark Health (Trenton, NJ)
- …accuracy and productivity requirements. + Assists with Regulatory Audits by performing first coding review and ranking of charts. Build partnerships and work ... not limited to Hierarchical Condition Category (HCC) Coding , medical coding , clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid… more
- St. Luke's University Health Network (Allentown, PA)
- …role is a Certified Medical Coder who ensures clean claim submission and timely review and resolution of coding related claim denials for professional services, ... coding , compliance, and documentation guidelines + Resolve Charge Review and Claim Edit CCI/LCD edits, diagnosis coding...the only Lehigh Valley-based health care system to earn Medicare 's five-star ratings (the highest) for quality ,… more
- Humana (Trenton, NJ)
- …they need, when they need it. These efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service ... of our caring community and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure… more
- Penn Medicine (Bala Cynwyd, PA)
- …and chart seminars + Provides assistance and support when necessary, to Compliance and Quality Review Analyst to include but not limited to: + Ensuring accuracy ... review with an emphasis on documentation requirements + ICD-10-CM and CPT/HCPCS coding experience + Knowledge of Medicare regulations + Experience public… more
- Virtua Health (Mount Laurel, NJ)
- …by US News and World Report, we've received multiple awards for quality , safety, and outstanding work environment.In addition to five hospitals, seven emergency ... core of our nursing culture. Virtua Home Care is a large, Medicare -certified home health agency that provides multidisciplinary skilled services in Burlington,… more
- Humana (Trenton, NJ)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... their daily work The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...need it. These efforts are leading to a better quality of life for people with Medicare ,… more
- Humana (Trenton, NJ)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, ...need it. These efforts are leading to a better quality of life for people with Medicare ,… more
- Bristol Myers Squibb (Princeton, NJ)
- …data) + Collaborate and educate matrix partners about reimbursement/access landscape (ie, coding , reimbursement and payer polices related to Medicare , ... This individual will work closely with hub vendors to monitor activities for quality and consistency. This position is ideal for someone who enjoys the day-to-day… more
- St. Luke's University Health Network (Bethlehem, PA)
- …Hospital. SLUHN is the only Lehigh Valley-based health care system to earn Medicare 's five-star ratings (the highest) for quality , efficiency and patient ... for the practice including, but not limited to, patient registration, coding diagnoses, insurance verification, and charge entry. JOB DUTIES AND RESPONSIBILITIES:… more
- St. Luke's University Health Network (Bethlehem, PA)
- …Hospital. SLUHN is the only Lehigh Valley-based health care system to earn Medicare 's five-star ratings (the highest) for quality , efficiency and patient ... the Cancer Data Registrar has responsibilities for the collection and coding of demographics, cancer identifying elements, definitive treatment, extent of disease,… more
- Humana (Trenton, NJ)
- …they need, when they need it. These efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service ... and analysis of data requires an in-depth understanding of reimbursement, coding , physician fee schedules, CIS and Humana's claims payment platforms. The… more
- Virtua Health (Mount Holly, NJ)
- …medical practice or ambulatory medical setting. Knowledge of insurance (ICD-9 CPT coding , Medicare regulations, state regulations, CLIA, DOH, and OSHA ... by US News and World Report, we've received multiple awards for quality , safety, and outstanding work environment.In addition to five hospitals, seven emergency… more
- St. Luke's University Health Network (Allentown, PA)
- …Hospital. SLUHN is the only Lehigh Valley-based health care system to earn Medicare 's five-star ratings (the highest) for quality , efficiency and patient ... patient record. + Performs charge reconciliation for the assigned clinical department(s). Review and balance charge reconciliation report each day for accuracy. +… more
- St. Luke's University Health Network (Allentown, PA)
- …and noise level. + Possesses basic knowledge of medical terminology and coding . + Corrects charge review errors. Handle registration/billing edits, practice ... the only Lehigh Valley-based health care system to earn Medicare 's five-star ratings (the highest) for quality ,...earn Medicare 's five-star ratings (the highest) for quality , efficiency and patient satisfaction. It is both a… more
- Cardinal Health (Trenton, NJ)
- …preferred + Patient Support Service experience, preferred + Clear knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers' policies and guidelines ... 1-2 years of Pharmacy and/or Medical Claims billing and Coding work experience + 1-2 years' experience with Prior...with high volume production teams with an emphasis on quality + Intermediate to advanced computer skills and proficiency… more
- Cardinal Health (Trenton, NJ)
- …equivalent preferred * Patient Support Service experience, preferred * Clear knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers policies and guidelines ... 1-2 years of Pharmacy and/or Medical Claims billing and Coding work experience * 1-2 years experience with Prior...with high volume production teams with an emphasis on quality * Intermediate to advanced computer skills and proficiency… more
- Sedgwick (Philadelphia, PA)
- …claimant and client. + Ensures claim files are properly documented and claims coding is correct. + May process complex lifetime medical and/or defined period medical ... filings and decisions on appropriate treatments recommended by utilization review . + Maintains professional client relationships. **ADDITIONAL FUNCTIONS and… more