Auditor who is responsible for performing DRG validation (clinical/coding) reviews of medical records... accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes. Adheres to official coding guidelines...
Description Support compliance excellence at UCLA Health by joining our team as a Compliance Auditor, MAPD, focused... and/or equivalent experience. Certified Professional Coder (CPC) or Certified Coding Specialist (CCS), highly desired. 5 or more years...
. Responsibilities: As a Premium Auditor, you’ll play a critical role in ensuring accurate premium calculations and compliance... as needed Respond to inquiries from agents, customers, and underwriters professionally and accurately Verify claims coding accuracy...
and mentoring the auditor and providing documented and validated findings. Encourage critical thinking and discussion among team... Types to include SNF, IRF, and HH. Train Clinicians with coding certifications on coding principles. Confer...
and a passion for getting the details right? Join EXL as a Clinical Validation Auditor and help ensure medical claims are coded... and coding knowledge to spot inaccuracies and identify potential overpayments. Document your findings in clear, professional...
Job Category: Administration Job Description: Lead Compliance Auditor - Heavy Anesthesia & Healthcare Expertise... impact? FlexStaff is seeking a dynamic, detail-oriented Lead Compliance Auditor to join our client's team and lead the charge...
Quality Assurance Analyst (Insurance Auditor Focus) – Pittsburgh, PA 15219 (Downtown) Status: Full-Time Shift: Day... Risk Integrity department in Pittsburgh, PA. This role functions as a critical Insurance Auditor Analyst, primarily...
clients, the auditor leverages deep clinical and coding expertise to identify improper payments, ensure documentation...Purpose The DRG Auditor Clinical Appeals is responsible for conducting comprehensive retrospective reviews...
Health (CH) Health Information Management (HIM) Educator/Auditor is responsible for providing Provider Coding education... that are provided. The Educator/Auditor will introduce new providers to the coding program requirements across CHS/Trinity and provide...
the cures of tomorrow to the people who need them today. The Hospital Compliance Auditor conducts audits systemwide..., and hospital billing including detection and correction of documentation, coding, and billing errors and/or medical necessity...
Responsibilities Analyzes and Audits Claims. Integrates medical chart coding principles, clinical guidelines... and objectivity in performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical guidelines...
coding. 6. Knowledge of CMS, third party payer and Joint Commission regulations, quality improvement processes...
schedules, coding guidelines, healthcare regulations and medical compliance. Monitors billing for trends. Communicates... designations such as coding certifications from AHIMA/AAPC/CMAS. Maintains strong written and verbal communication and negotiation...
billing schedules and policies, as well as Current Procedural Terminology (CPTs) and Healthcare Common Procedural Coding...
schedules, coding guidelines, healthcare regulations and medical compliance. Monitors billing for trends. Communicates... designations such as coding certifications from AHIMA/AAPC/CMAS. Maintains strong written and verbal communication and negotiation...
and audits. Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events... monthly and quarterly reports outlining trends. Serves as a resource in resolving coding issues. Coordinates HIPAA and legal...
Familiar with Medi0Cal and/or managed care claims processing. Knowledge of CPT, HCPC procedure coding, and ICD -9/ICD10... diagnostic coding. Typing speed 30 wpm and proficient use of 10-key calculator. Familiar with AMISYS or similar claims systems...
), Adaptive Predictive Coding (APC), and Never Events across all lines of business. Coordinating rate adjustments with claims... areas. Providing monthly and quarterly reports outlining trends and serving as a resource in resolving coding issues...
diploma or GED required. Alabama nursing license (RN or LPN) preferred. Prior clinical or coding experience... Accounting, Chargemaster, coding, compliance or related field. Proficient in use of Microsoft Word and Microsoft Excel. Able...