Senior Medical Review Coding Appeals Auditor

As a Clinical Appeals Auditor with Shared Services, you will play a key role in ensuring the accuracy and integrity of clinical documentation. You will work closely with the Governmental Audit Supervisor to review and respond to governmental audits, including ADRs, RACs, CERTs, a ...

This role involves auditing clinical documentation for Home Health, Hospice, LTACHs and Community-Based Services in response to governmental audits. · ...

Job summaryThe Quality Assurance Auditor is responsible for performing Internal Quality Assurance Audits of Operational processes for internal employees and outsourced vendors to ensure compliance with policies, procedures and quality standards. · ...

The Quality Assurance Auditor is responsible for performing Internal Quality Assurance Audits of Operational processes to ensure compliance with policies and quality standards. · Investigate audit conduct root cause analysis handle processing of determinations track and trend fin ...

The Quality Assurance Auditor is responsible for performing Internal Quality Assurance Audits of Operational processes for internal employees and outsourced vendors to ensure compliance with policies, procedures and quality standards. · Conduct quality audits of A&G items includ ...

The Quality Assurance Auditor is responsible for performing Internal Quality Assurance Audits of Operational processes for internal employees and outsourced vendors to ensure compliance with policies, procedures and quality standards. · ...

The Clinical Auditor performs audit functions for clinical teams and delegated vendors and partners within internal timeframes to assess operational efficiency, · regulatory compliance, and quality standards.Maintain tracking tools to log audit results and identify areas of non-c ...

+Job summary · The Clinical Auditor performs audit functions for Healthfirst clinical teams (e.g. Care Management, Reassessment/Clinical Eligibility, Utilization Management, etc.) ++NYS LPN or RN license. · In order to access the Uniform Assessment System (UAS), an unexpired NYS ...

The Medical Review Coding Appeals Auditor (Outpatient) is responsible for conducting appeals reviews of new evidence presented by auditees, · disputing all or part of the findings from medical review audit work completed by the medical review coding audit team members Communicate ...

The Medical Review Clinical Appeals Auditor (RN) conducts appeals reviews of medical records to maintain subject matter expertise. They are responsible for objectively documenting appeals results in accordance with department quality policies. · ...

Under the direction of Compliance Officer, within Department of Compliance Audit and Appeals, · Nurse Auditor will be responsible for responding to external audits including writing appeals, · ...

The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all diagnosis and procedure codes to assure properly assigned MS-DRG or APR-DRG for the purpose of appealing proposed DRG and coding changes by insurance providers ...

The DRG Denials Auditor conducts hospital inpatient DRG denial audits for both RAC · and non-RAC accounts. · Essential FunctionsPerforms inpatient denial reviews using ICD-10-CM/PCS · ...

The Supervisor Clinical Appeals oversees the coordination of audit and medical necessity denial appeals for their assigned team. · Supervises the team responsible for reviewing preparing and submitting medical necessity denial appeals in accordance with standardized processes and ...

The Medicare Audit Risk Management is responsible for managing Medicare accounts receivable, · The Auditor works closely with billing, coding, clinical, and compliance teams to protect revenue while maintaining compliance with CMS and MAC requirements. · ...

This position has the responsibility of building patient accounts in the denials management system and performing timely follow-up with regard to clinical and medical necessity insurance appeals. · Analyze denials and coordinates insurance appeals. · ...

This position has the responsibility of building patient accounts in the denials management system and performing timely follow-up with regard to clinical and medical necessity insurance appeals. · Analyzes all correspondence regarding insurance denials for the Revenue Integrity ...

This position provides leadership direction and training for the financial services staff with regard to clinical and medical necessity insurance denials Analyzes all correspondence regarding insurance denials for the revenue integrity auditor to take appropriate action Prepares ...

Manages and reviews clinical denial appeals to payers. · ...

The Compliance Bill Auditor is responsible for bill auditing to ensure charges were billed accurately. · ...