Regularly performs limited volume of Inpatient coding reviews on medical records to maintain subject matter expertise, and additionally as needed to support business needs. Performs audit quality assurance reviews to supplement QA team activity as necessary based upon business need or special projects. Contributes to the resolution of quality review rebuttals. Performs ap

Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules. Document all findings referencing the appropriate policies and rules. Generate letters articulating audit findings. Supporting your findings during the appeals process if requested. Working collabor

Every day, Baxter touches the lives of millions of patients and providers worldwide who rely on our essential hospital and renal products and services. You’ll find Baxter’s products and therapies on nearly every floor, in almost every hospital worldwide, in clinics and in the home. Baxter’s employees are building upon the company’s rich heritage of

Health Information Specialist I (Onsite Redwood City, CA. 94063) Job Locations US CA Redwood City Requisition ID 2024 35120 # of Openings 1 Category (Portal Searching) Operations Position Type (Portal Searching) Employee Full Time Equal Pay Act Minimum Range $19.00 $21.00 per hour Overview Who we are... Datavant protects, connects, and delivers the world's health data to

El Camino Health is committed to hiring, retaining and growing the best and brightest professionals who will carry our mission and vision forward. We are proud of our reputation in the community One built on compassion, innovation, collaboration and delivering high quality care. Come join the team that makes this happen. Applicants MUST apply for position(s) by submitting

Responsible for the review and update of existing concepts based upon required periodic review cycle or as needed based upon client or regulatory changes (research, analysis, update rule documents, code lists and edits accordingly). Collaborates with and leverages Segment Specialist expertise to ensure on point results. Ensure training material updates (may develop or coo

ly and accurately conduct coding reviews on medical records for assigned client audit contract in accordance with the statement of work while meeting compliance, productivity, and quality expectations. Conduct review of flagged claims and Fraud Waste & Abuse (FWA) referrals involving suspected upcoding, unbundling, anomalous coding, intentional miscoding, etc. Timely revie

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Provide project coordination and administrative support for NCQA and Process Improvement activities. Support the Health Homes Program by coordinating meetings, documenting workflows, maintaining meeting minutes, creating and reviewing reports, and provi

Referral Coordinator The Referral Coordinator is responsible for all administrative processing in regard to patient's personal and insurance information for a group of dialysis clinics. This individual cooperates and works closely with both internal and remote co workers, possesses strong time management skills and the ability to complete assigned job duties with applicab

Job Title Clinical Safety Coder Location 100% Remote Duration 12 Months Ability to accurately code clinical trial data using MedDRA and WHODrug by company conventions. Ability to effectively perform all Clinical Coding Team workflow requirements through the life of the trial Ability to support the identification of the prohibited medications and/or other related exclusion

Determines and facilitates appropriate action for claim resolution and correct financial responsibility via DOFRs, IPA and health plan/IPA contacts. Effectively uses detailed documentation in EMR and/or billing system(s) of all activities undertaken. Maintains timely follow up on outstanding insurance claims in appropriate EPIC WQs, ensuring claims are billed/rebilled wit

Referral Coordinator Temporary Employment Program Temporary Employment 76918BR Job Summary This opportunity is approximately three months. Includes optional medical benefits, holiday pay and sick leave accrual. Department OVD Pediatric Referral Center Responsibilities New Patient Scheduling and Processing Review and manage referrals. Be the primary contact for referring p

Referrals Coordinator Job Locations US CA Berkeley ID 2024 5679 Overview LifeLong Medical Care is looking for a Referrals Coordinator at our West Berkeley Health Center. The Referrals Coordinator is part of a patient centered care team. Responsibilities include providing specialty referrals, follow up, data entry and tracking. This is a full time, 40 hrs/wk, benefit eligi

In this position of IRB Manager (RCM1), under the direction of the Sr. IRB Manager and the IRB Chair, you will conduct in depth protocol review using advanced regulatory knowledge and experience. The primary responsibility will be to manage the protocol review process and identify issues, and to independently determine whether the components of the proposed research are i

Reporting to the University Registrar and led by the Assistant Registrar, the Records and Registration Coordinator must possess knowledge of procedures related to records and registration as expressed in Title 5, California State University (CSU) Executive Orders and San Jose State campus based in order to provide advising to students, and consultation to staff and facult