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📑 The Quality Assurance Team Lead will manage the daily QA functions at company headquarters. Must have substantial experience in healthcare claims coding, documentation auditing, and leadership.Responsibilities:Ensure the accuracy and timeliness of chart note processing, and implement policies and procedures to optimize workflowsAnalyze data and ide ...

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📑 Regulatory Compliance Clinical Auditor, HybridFull-timeShift: DayPosition Type: ExemptIf relocating locally to Maryland, please note that in your application.This position requires experience with utilization review in a hospital setting.At the University of Maryland Medical System (UMMS), the health of Maryland is ourmission — and our passion. We ...

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📑 Nurse Auditor Regulatory Compliance, HybridFull-timeShift: DayPosition Type: ExemptIf relocating locally to Maryland, please note that in your application.A successful candidate will have a clinical background as an RN or LPN, in conjunction with direct experience in hospital auditing, joint commission, patient criteria knowledge, and hospital codi ...

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📑 Nurse Auditor Regulatory Compliance, HybridFull-timeShift: DayPosition Type: ExemptIf relocating locally to Maryland, please note that in your application.A successful candidate will have a clinical background as an RN or LPN, in conjunction with direct experience in hospital auditing, joint commission, patient criteria knowledge, and hospital codi ...

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📑 Nurse Auditor Regulatory Compliance, HybridFull-timeShift: DayPosition Type: ExemptIf relocating locally to Maryland, please note that in your application.A successful candidate will have a clinical background as an RN or LPN, in conjunction with direct experience in hospital auditing, joint commission, patient criteria knowledge, and hospital codi ...

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📑 Clinical Auditor Regulatory Compliance, HybridFull-timeShift: DayPosition Type: ExemptIf relocating locally to Maryland, please note that in your application.A successful candidate will have a clinical background as an RN or LPN, in conjunction with direct experience in hospital auditing, joint commission, patient criteria knowledge, and hospital c ...

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📑 Nurse Auditor Regulatory Compliance, HybridFull-timeShift: DayPosition Type: ExemptIf relocating locally to Maryland, please note that in your application.A successful candidate will have a clinical background as an RN or LPN, in conjunction with direct experience in hospital auditing, joint commission, patient criteria knowledge, and hospital codi ...

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📑 Job Description - Senior Claims Auditor (3280344) Senior Claims Auditor ( Job Number: 3280344 ) This is a remote position that can be done in most US states. Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with o ...

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📑 Position Overview : The DRG Validation Nurse Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines and rules, evidence based clinical criteria plan, and policy exclusions. Conduct reviews on inpatient DRG cla ...

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📑 Compass Healthcare Consulting & Placement is conducting a search for an experienced RN Coder for a REMOTE opportunity with a Certified Home Healthcare agency located in New York, NY. Qualified candidates will have at least 3 years of CHHA Certified Home Healthcare Agency Clinical Documentation experience, have a strong knowledge of CHHA rules and g ...

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📑 Job Title: Data AnalystDuration: 12 Months Location: Fort Lauderdale, FL (Remote) Responsibilities:Architect, design, and develop high-quality software solutions using Java, Scala, and Python. Address complex technical challenges and spearhead refactoring initiatives to improve code quality. Demonstrate hands-on coding expertise and deep understand ...

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📑 The Software Validation Specialist will collaborate closely with the Clinical Quality Assurance Lead for Systems Audits, focusing on audit and quality Participate in computer system audits to review SDLC and data integrity controls. Review CAPA and verify CAPAs of system audits. Act as a QA approver for internal validation efforts. Serve as a ...

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📑 ChristianaCare is searching for a Corporate Compliance & Privacy Auditor to join the team.This position will execute moderate-to-complex level audits and participate in the evaluation of the adequacy, effectiveness, and efficiency of internal controls and identify weaknesses, along with providing recommendations to mitigate those weaknesses. This p ...

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📑 A health services organization in New York City is currently seeking an experienced professional to join their staff as their new Director of Claims Quality. In this role, the Director of Claims Quality will be responsible for the creation, delivery and ongoing facilitation of a data and metrics-driven Claims Quality Assurance and Performance overs ...

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📑 4/10 shift! In Office Medical ExaminersThis Jobot Job is hosted by: John NacyAre you a fit? Easy Apply now by clicking the Apply button and sending us your resume.Salary: $60,000 - $70,000 per yearA bit about us:Our client is looking for experienced Medical Claims Examiners and Auditors for immediate, long term needs.Why join us?MedicalDental Vis ...

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📑 Overview The Data Scientist II will apply knowledge and experience to real world problems, and seek to utilize their skills reduce the cost of healthcare and improve health quality and outcomes. With access to dedicated on premise and cloud based big data solutions, the team can work with a vast amount of structured a ...

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📑 Job Summary: Communicates with patients, government agencies and third party payers to gather, process and record information to receive appropriate reimbursement. Communicates with departments for charge information, coding updates, and other information for claim appeals. Completes billing and collection processes a ...

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📑 A health services organization in New York City is currently seeking an experienced professional to join their staff as their new Director of Claims Quality. In this role, the Director of Claims Quality will be responsible for the creation, delivery and ongoing facilitation of a data and metrics-driven Claims Quality Assurance and Performance ov ...

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📑 Are you looking for a new opportunity to grow your existing skillset while also gaining valuable experience to grow your own career? Our client, a nationally recognized healthcare provider, rewards teamwork, quality and innovation with opportunities for growth and development. Their fast-growing team has opportunities to learn and grow ...

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📑 Quality DirectorJob ID: 1971Location:San Diego, CAType:PermanentStatus:OpenKey Skills: Quality Assurance, Management, ISO 900/1/14001 Quality Systems Auditing, IPCA, printed circuit board, electronics, failure analysis, DOE, SPC, PFMEA Description:Seeking Quality Director to join dynamic team of leading manufacture of Machine to Machine (M2M) mode ...

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📑 Head of Assurance Technology About the Company Well-established organization providing high-quality services IndustryInformation Technology and Services TypePublic Company About the Role The Company is seeking a Head of Assurance Technology to lead its strategy in technology use and related projects ...

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📑 **JOB DESCRIPTION** **Job Summary** **Job Summary** Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials. **KNOWLEDGE/SKILLS/ABILITIES** + Performs on-g ...

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📑 Description: Position: Credentialing Specialist -Hybrid: Remote & In-office (as needed) This position reports to the Director of Provider Services and is responsible for full cycle credentialing of Providers and Facilities. Position must have experience with facility credentialing of Hospitals, SNF, Home Health, Radiology etc. The role will work cl ...

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📑 Femwell Group Health is Florida’s leading management services organization (MSO) providing cost-effective business solutions so physicians can efficiently and profitably run their practices.From managed care support to accounting and marketing, the members of our team work with physicians every step of the way to maximize productivity and ...

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📑 Femwell Group Health is Florida’s leading management services organization (MSO) providing cost-effective business solutions so physicians can efficiently and profitably run their practices.From managed care support to accounting and marketing, the members of our team work with physicians every step of the way to maximize productivity and efficienc ...

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📑 Duration: 12 months contract, Full-TimeEmployment Type: W-2Work schedule:• Preferred onsite in Mettawa.• Open to remote for experienced candidates with Medical Claims and EMR experience.Description: The Data Scientist provides analytical support to Scientific Communications and Medical Affairs & HEOR. This position will report to the Director RWE A ...

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📑 JOB TITLE: Remote Medical Claims AuditorJOB LOCATION: Remote WAGE RANGE*: $17hr to $18hrJOB NUMBER: (phone number removed)REQUIRED EXPERIENCE:Must have demonstrated experience and knowledge of healthcare claims processing (Medicaid, Medicare, Commerc ...

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📑 ***This person must reside in Kansas***Healthcare Fraud Shield, a leader in healthcare fraud prevention and payment integrity solutions, is looking for a talented Coder or Clinical Coder/Fraud Investigator to join our team.RESPONSIBILITIESWork with SIU Team (Clinical Reviewers, CPCs, Investigators, Analysts-including performing quality check on wor ...

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📑 Duration: 12 months contract, Full-TimeEmployment Type: W-2Work schedule:• Preferred onsite in Mettawa.• Open to remote for experienced candidates with Medical Claims and EMR experience.Description: The Data Scientist provides analytical support to Scientific Communications and Medical Affairs & HEOR. This position will report to the Director RWE A ...

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📑 Job DescriptionCHUBB NORTH AMERICA CLAIMS - VP of QUALITY ASSURANCE KEY OBJECTIVE:This individual is responsible for the North America (NA) Claims Quality Assurance function. Major technical functions include Casualty, Workers Compensation, Property, Auto and Financial Lines. The individual will lead a team of Quality Assurance leaders and audit pr ...

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📑 Director of Quality AssuranceLocation: Miami, FLWorking Situation: HybridLevel: DirectorWe are currently seeking a talented and experienced Director of Quality Assurance to join our team in Miami, FL. We are an innovative medical device company focusing on Class III devices. This permanent position offers an exciting opportunity for a Quality Assur ...

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📑 Lead Billing SpecialistStep Range 15 ($41,686) – 34 ($73,098) Full Benefits Regular - Full-TimePOSITION OBJECTIVE The Lead Billing Specialist will be responsible for assisting in all aspects of the coding and billing cycle for Klamath Tribal Health & Family Services (KTH&FS). This will include, but not limited to, daily review of encounters ...

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📑 WHO WE AREEvergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care. We are committed to improving patient outcomes and improving quality of life by delaying disease pr ...

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📑 POSITION SUMMARYPromotes and maintains the quality and accuracy rate of claims paid by Community Health Group. Conducts pre-disbursement audits for fee for service claims. The Claims Auditor compiles, tracks and trends audit results and recommends suggests training and other improvement ideas.COMPLIANCE WITH REGULATIONSWorks closely with all depart ...

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📑 When you join the healthcare team at Phoenix Children’s, you’ll see the world of medicine through the eyes of a child. You’ll be amazed by something new every day, inspired by the capabilities and expertise of your co-workers, and you’ll be able to transform your professional ambitions into realities. Here, you can be part of a growing system that ...

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📑 Hi There,We have a job opening with one of our clients. Please find the below details and let me know if you are interested to discuss further.Role: Medical coding Auditor (DRG)Location: Remote/Travel/ San Antonio TX, Nashville TNType: Full-timeOur Client is hiring a DRG Auditor III. This Hybrid role requires auditing in specific provider location ...

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📑 Compliance Facility Coding and Billing Auditor Department: CNE-CORP COMPLIANCE Operating Unit Care New England Location: Providence, RI Job ID: 19180 Job Status: Full Time Shift: Days Schedule: Other *This position will be a hybrid schedule.*Job Summary:Provides audit support and guidance to management, providers, residen ...

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📑 Sr. Quality Assurance Specialist Job Summary The Sr. Quality Assurance Specialist will be an essential member of the RedSail team, who will be responsible for establishing and delivering on high quality standards that enable RedSail to delivery against our quality OKRs, ensuring on-time and error-free software delivery. This individual will play a ...

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📑 Provides audit support and guidance to management, providers, residents, and support staff in free-standing and facility-based practices.Conducts assigned compliance audits for risk areas identified through the analysis of internal data and external sources.Ensures all coding, billing, and documentation complies with federal and/or state regulation ...

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📑 Job Description Description Responsible for ensuring that unpaid and partially paid claims are resolved in an efficient and timely manner. Resolves EOB discrepancies and researches refunds. Monitors and ensures that collections, net, gross and days in accounts receivable targets are met. <br/ ...

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📑 Job Description Registered Nurse IB - Long Term CareCasual Location: John M Gray Centre, St. AnthonyThe primary purpose of this position is to work as an active member of the nursing team to provide a high standard of care to residents of the John M Gray Centre. The Registered Nurse (RN) will assume a leadership ro ...

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📑 Title: DRG AuditorLocation: Nashville, TN, USA & San Antonio, TX (Remote but travel needed)Job Type: Full timeOur Client is hiring a DRG Auditor III. This Remote role requires auditing in specific provider location in San Antonio, TX and Nashville, TN. To be onsite at the provider location will require some travel each quarter. The amount of travel ...

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📑 Title: DRG AuditorLocation: Nashville, TN, & San Anoint, TXJob Type: Full timeEXL Health is hiring a DRG Auditor III. This Remote role requires auditing in specific provider location in San Antonio, TX and Nashville, TN. To be onsite at the provider location will require some travel each quarter. The amount of travel outside the metropolitan area w ...

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📑 Quality develops and implements quality policies, procedures, and processes to ensure products and services comply with regulatory standards and specifications. Quality Assurance develops and implements a compliant and cost effective quality system that assures products and services are reliable, safe and effective. This ...

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📑 PRINCIPAL RESPONSIBILITIES:Under general direction from the Director, Claims, the Senior Manager, Claims Operations Support is responsible for the management and oversight of the Claims Operations Support function which includes, but is not limited to, research and resolution of claim payment issues, auditing, refund processing and claims system an ...

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📑 Posted Date7/26/2023Department(s):Claims AdministrationReports to:Manager ClaimsFLSA status:Non-ExemptSalary Grade:J - $65,000 - $106,106Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is onWednesday, August 9, 2023 at 11:59 ...

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📑 General Dynamics Information Technology (GDIT) provides healthcare information technology services and resources to support the Center for Medicare and Medicaid Services (CMS). As an IT Quality Analyst Advisor, you will provide testing and analysis to support the Medicare Part D Prescription Drug program. HOW YOU WILL MAKE AN IMPACT ...

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📑 DescriptionSummary:HCC Coding Auditor Senior will perform code audits and abstraction using the Official Coding Guidelines for ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The HCC Coding Audit ...

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📑 Job DescriptionJob DescriptionProvider Relations SpecialistHomestead Smart Health PlansPhila., PA(Hybrid role)Homestead Smart Health Plans has an immediate opening for an organized, detail-oriented, and experiencedProvider Relations Specialist.The Provider Relations Specialist is responsible for the full range of provider re ...

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📑 This is your opportunity to join AXIS Capital - a trusted global provider of specialty lines insurance and reinsurance. We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders. We also proudly maintain an entrepreneurial, disciplined and ethical corporate culture. As a mem ...

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