- The Cigna Group (Nashville, TN)
- **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
- HCA Healthcare (Brentwood, TN)
- **Description** **Introduction** Do you have the career opportunities as a Denial Coding Review Specialist you want with your current employer? We have an ... colleagues. Do you want to work as a(an) Denial Coding Review Specialist where your passion for...met in compliance with departmental policies and procedures + Review Medicare Recovery Audit Contractor (RAC) recoupment… more
- Highmark Health (Nashville, TN)
- …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
- Humana (Nashville, TN)
- …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
- Humana (Nashville, TN)
- …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 ... part of our caring community and help us put health first** The Coding Educator 2 identifies opportunities to improve provider documentation and creates an education… more
- Elevance Health (Nashville, TN)
- …a proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative services to Medicaid ... of Care, trend management, value-based care support for STARS/HEDIS and correct coding initiatives with providers as well as strategic growth and innovation… more
- HCA Healthcare (Nashville, TN)
- …to coding . This is a great position for those wanting to move from production coding toward a coding quality reviewer role or for someone interested in ... that we continue to provide all patients with high quality , efficient care. Did you get into our industry...**Job Summary and Qualifications** **We are seeking an Inpatient Coding Resolution Specialist for our center to ensure that… more
- LifePoint Health (Brentwood, TN)
- *DRG Downgrade Specialist* *Who we are:* At Lifepoint Health, we provide quality healthcare to rural communities. As a valued member of our team, you will be an ... *What you'll do:* As a*DRG Downgrade Specialist*, you willconduct a thorough review of the medical record and drafting appeal letters, preparing for peer-to-peer… more
- Humana (Nashville, TN)
- …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
- Humana (Nashville, TN)
- …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
- CenterWell (Smyrna, TN)
- …+ Completes all medical record documentation in a timely manner working with a quality - based coder to optimize coding specificity. + Follows policy and protocol ... defined by Clinical Leadership. + Meets with RMD about quality of care, review of outcome data,...Medicine preferred + Active and unrestricted DEA license + Medicare Provider Number + Medicaid Provider Number + Minimum… more
- HCA Healthcare (Nashville, TN)
- …health, public nursing or acute hospital nursing experience 3. Familiar with Medicare home health regulations, documentation requirements, ICD-10 coding and PPS ... to establish and achieve patient goals and maintain high quality patient care. Performs in accordance with physician's orders... care during their recovery at home. We are Medicare certified. Our patients are under the supervision of… more
- Sedgwick (Nashville, TN)
- …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
- Sedgwick (Nashville, TN)
- …claimant and client. + Ensures claim files are properly documented and claims coding is correct. + May process low-level lifetime medical and/or defined period ... filings and decisions on appropriate treatments recommended by utilization review . + Maintains professional client relationships. **ADDITIONAL FUNCTIONS and… more