- Associates degree required.
- RN with a valid New York State license required.
- CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) required, or must be obtain within first year of employment.
- A minimum of one (1) year clinical experience required.
- A minimum of two (2) years quality/utilization review experience in an HMO, managed care organization, or similar experience as a hospital inpatient coder or auditor required.
- Experience with data retrieval, analysis, and case summarization is required Familiarity with statistics and clinical management/cost containment issues preferred.
- Demonstrated ability to review health care delivery against established criteria.
- Demonstrated experience working with Microsoft Office, including Outlook, Word and Excel, and other databases.
- Demonstrated knowledge of ICD-10 diagnosis and procedure codes, CPT codes, Revenue codes, HCPCS codes.
- Demonstrated ability to pro-actively identify problems, as well as recommend and/or implement effective solutions.
- Demonstrated ability to work with and maintain confidential information.
- Demonstrated ability to provide excellent customer service and develop relationships both internally and externally.
- Excellent verbal and written communication skills.
- Flexibility to adapt to a changing and fast-paced environment.
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Certified Medication Aide
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life care center of America New Albany, United StatesThis QMA position will oversee scheduling for nurses and aides in the building. Previous experience strongly desired. Position Summary · The Certified Medication Aide delivers quality care to patients during the admission and readmission process in accordance with all applicab ...
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nurse practitioner or physician assistant
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landmark health Albany, NY , USA, United States$40,000 Student Loan Repayment Or $30,000 Sign-on Bonus For Individuals Who Have Not Previously Participated In This Program · Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-lead ...
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home health aides and personal care aides needed
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LPN Assessment Nurse SOURCE
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Medical Assistant
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Medicaid Special Programs Assessor Care Manager
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CDPHP Albany, United States Regular Full timeGrounded by a compelling mission, core values, and compassion for people, CDPHP and its family of companies offer a strong foundation for a rewarding career. Established in 1984, CDPHP is a physician-founded, member-focused, and community-based not-for-profit health plan that off ...
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Medical Assisting
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Chef
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ADT Albany, United States Full timeCompany Overview: The next generation of ADT Commercial is here. At Everon, we truly believe that our people are the difference – for our organization, the customers we serve and the communities we protect. When you're a part of Everon, you'll have the opportunity to be a part o ...
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Registered Nurse
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Adult STAT RN
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Adult STAT RN
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Clinical Nurse I
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Clinical Nurse I: B3: General Surgery/Trauma
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Clinical Nurse I- B3: General Surgery/Trauma
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Clinical Nurse I- B3: General Surgery/Trauma
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Revenue Integrity Recovery Coordinator
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Clinical Nurse I
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clinical review and coding nurse - Albany, NY , USA, United States - Capital District Physicians' Health Plan, Inc.
Description
CDPHP and its family of companies are mission-driven organizations that support the health and well-being of our customers and the communities we are proud to serve.
CDPHP was founded in Albany in 1984 as a physician-guided not-for-profit, and currently offers health plans in 29 counties in New York state.
The company values integrity, diversity, and innovation, and its corporate culture supports those values wholeheartedly.At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities.
CDPHP invests in employees who share these values and invites you to be a part of that experience.
The Clinical Review and Coding Nurse is responsible to attain procedure and diagnosis coding accuracy and consistency on referred cases.
The RN will perform and coordinate the clinical component of the provider appeal function including communication of the decision on whether to uphold the original payment.
The RN will support provider audit functions including assessment of coding, practice trends and evaluation of programs, and recommend areas for improvement.
The RN will also research new technology or services and recommend updates to medical policies.QUALIFICATIONS:
In addition to cash compensation, CDPHP employees may be eligible for an incentive payment, a discretionary cash reward based on employee and company performance.
Some roles may also be eligible for overtime pay.CDPHP compensation packages go far beyond just salary.
The company offers a comprehensive total rewards package that includes award-winning health care coverage, health care dollars, a generous paid time off allowance, employee assistance programs, flexible work environment, and much more.
Learn about all CDPHP employee benefits here.
As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices on the basis of race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law.
CDPHP and its family of companies include subsidiaries Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRX Services, LLC.