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FEED

Preferred skills, qualifications and experiences: One or more of the following certifications are preferred: Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background.

YEAR

Elevance Health

Patient Safety DRG Clinical Validation Auditor

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FULL_TIME

OTHER

In support of TRICARE beneficiaries enrolled in the Autism Care Demonstration (ACD), the Autism Services Navigator (ASN) collaborates and oversees the assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services for TRICARE beneficiaries diagnosed with autism spectrum disorder (ASD). • Current unrestricted licensure in an appropriate state or territory of the United States, as a Licensed Independent Clinical Social Worker (LICSW), Licensed Clinical Social Worker (LCSW), Registered Nurse, or other licensed mental health professionals who possess a Certification in Case Management (CCM).

TriWest Healthcare Alliance

Autism Services Navigator

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2 temps needed to support year end push initiatives for hedis team to complete the year round measures specific projects needed to close gaps prior to the year end cutoff and then transition to supporting the hybrid project that includes 12 projects and medical record requests/reviews to increase star ratings across all the health plan lines of business. 1 Knowledge of NCQA technical specifications and how to navigate and utilize them 2 Medical Terminology skills 3 Technical skills, excel, word and Microsoft office suite Candidate Review & Selection Shortlisting process.

Mindlance

Clinical - Quality Improvement Specialist (HEDIS) - 112274

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Technical Skills: Thorough knowledge of policies and procedures, knowledge of managed care principles and methods; medical terminology; proficiency in the application of clinical criteria: InterQual, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, current Procedural Terminology, and Healthcare Common Procedural Coding System, and American Dental codes; working knowledge with medical management systems; proficient with Microsoft Office; knowledge of UM Process; reporting techniques. • Prepares work schedules and monitors staff caseloads to ensure adequate staffing levels at all times and accurate data entry and application of the medical management system.

Supervisor, Utilization Management

Candidates must be experienced working natively in client source systems and must be capable of billing claims directly to payers include Medicare DDE/FISS, state Medicaid portals, and payer-specific direct submission channels. Submit clean claims directly to payers via Medicare DDE/FISS, state Medicaid portals, and payer-specific direct submission channels, working natively in client EHR and billing systems rather than exclusively via clearinghouse.

TIS International (USA) Inc

AR Specialist | Physician Billing

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Handles executive-level internal and external communications which includes; handling incoming phone calls, returning phone calls, responding to voice-mails, managing incoming e-mails by forwarding and responding to e-mails as appropriate, and creating and mailing letters and memos on behalf of Executive and department. Acts as project manager on assigned projects, provides administrative assistance as needed on other special projects and maintains departmental file sharing and intranet site(s), as requested.

Reinsurance Group of America Inc

Executive Assistant (open to remote)

The Patient Representative is responsible for the execution of duties associated with operation of the front desk area of the Lyon College School of Dental Medicine (LCSDM) Clinics to include, but not limited to: completing administrative and financial procedures associated with patient encounters, greeting patients upon arrival and exit of appointment, assisting patients with required paperwork, input of patient data into clinical software system, managing the appointment schedule for dentists, hygienists, & dental students, answering the telephone and returning calls, directing the appropriate use of patient information, and facilitating communication between students, patients, faculty, and staff. Oversees the maintenance of the patient schedule and recall system, ensuring clinic schedules are maintained at capacity in order to meet patient demand and maximize revenue & contacts patients to discuss follow-up on proposed treatment plans; calls patients to confirm appointments; reschedules patients when cancellations/vacancies occur to maintain schedule at capacity.

Lyon College

Patient Care Coordinator

Talent Acquisition

Routinely handles cases that are sensitive or high profile, those that are complex cases involving or cases involving multiple perpetrators or intricate healthcare fraud schemes. Demonstrates high level of knowledge and expertise during interactions and acts confidently when providing testimony during civil and criminal proceedings.

CVS Health offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at CVS Health, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible – for all.

CVS Health Corp

Senior Investigator, Special Investigations Unit (Aetna SIU)

Working with case managers or nurse case managers (if involved) to ensure appropriate medical care is provided and to facilitate a timely return to work (if applicable, though less common in medical-only claims). Answer phone calls and emails from insureds, agents, witnesses, and other parties involved in the claim, providing updates on claim status and answering general inquiries.

Triangle Insurance

Claims Analyst/Adjuster (Little Rock AR or Enid, OK)

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Applies clinical knowledge to make determinations for preauthorization, inpatient and continued stay reviews for Behavioral Health and Medical/Surgical requests to establish medical necessity, benefit coverage, appropriateness of quality of care, and length of stay or care plan. The Utilization Management Clinical Review nurse reviews and makes decisions about the appropriateness and level of beneficiary care being provided in an effort to provide cost effective care and ensure proper utilization of resources.

Utilization Clinical Reviewer

In this role, you will be responsible for analyzing, programming, debugging, building, deploying, testing, and documentation of applications in development and production environments, as well as database design and system testing and documentation. Expected deliverables include requirement analysis, system analysis, system design, data models, program design, source code development, unit test case development, unit and system testing, and documentation.

Cambia Health Solutions is a family of companies headquartered in Portland, Oregon, working to create a person-focused and economically sustainable health care system. 

Through our health plans, innovative technology and strategic investments, we are delivering consumer-centric solutions that:

•       help people achieve better health and well-being 
•       make health care more available, affordable and accessible 
•       are easily understood by everyone

We put people at the heart of everything we do. Our company reaches more than 70 million Americans nationwide, including more than two million people in the Pacific Northwest who are enrolled in our regional health plans.  

Cambia Health Solutions Inc

Data Platform Engineer III (HEDIS Support)

Cambia Health

Data Platform Engineer III (Hedis Support)

Complies with the Veterans Affairs Community Care Network (CCN) and TRICARE T-5 contracts; DHA and TRICARE program guidelines and pertinent Federal regulatory requirements; assists supervisors with FWA trending and reporting requirements; coordinates and assists with investigations and prosecutions by federal agencies interfaces directly with Veterans, Military members and family (as warranted), providers, subcontractors, and other TriWest departments on FWA issues; assist supervisor with the education and training of TriWest, subcontractor, and provider personnel on current FWA matters; prepares appropriate responses to provider compliance issues and complaints referred to Program Integrity by other TriWest departments or external referrals. The PI Investigator t is responsible for the identification, analysis, case development, and reporting of suspected fraud, waste and abuse (FWA) cases as defined by the Department of Veterans Affairs (VA), the Healthcare Finance Administration (HCFA) and the Department of Defense, Defense Health Agency for the TRICARE program; requests and reviews issue-related medical claims and records for FWA and/or administrative and clerical error(s).

Program Integrity Investigator

The successful candidate will collaborate with cross-functional enterprise teams, provide technical leadership, and leverage deep expertise in iOS development and Apple Health technologies to deliver secure, high-quality, and customer-centric digital products. CVS Health Digital is looking for hands-on, passionate people who want to join a high energy and growing team to make a difference in customers' lives and who want to be on the forefront of digital innovation that aims to reinvent what a pharmacy and a health care company can be in the digital world.

Staff Software Development Engineer - iOS

As a Senior Manager you will guide large projects, shape technical direction, and use sound judgment to coach teams, navigate complexity, and communicate clearly with stakeholders while driving process improvements and operational excellence. As a Senior Lead Engineer you will lead custom application development and testing efforts that help clients turn business needs into scalable software solutions across cloud-native and on-premise environments, within our Advisory practice.

PwC’s accounting practice originated in London well over a century ago. As times changed and PwC expanded worldwide, our commitment to clients—like you—never wavered. With us, you’re always supported by a global network of more than 223,000 people in 157 countries with one goal: to help your business thrive.

PwC’s professional services include audit and assurance, tax and consulting that cover such areas as cybersecurity and privacy, human resources, deals and forensics. We help resolve complex issues and identify opportunities across these industries.

Let’s combine your ​aspirations with our world-class capabilities to achieve your goals.

PricewaterhouseCoopers LLP

Senior Lead Engineer

Provides consultation on business requirements and functional specifications in logical program designs, code modules, application systems, and software solutions; facilitates the transition to high level design and supports the project lifecycle with input from leadership where needed. Serves as a technical lead for project teams throughout the implementation and maintenance of business and enterprise software solutions by leveraging partnerships with technology teams and business leaders to resolve escalated issues.

Old Dominion Freight Line Inc

Application Delivery Technical Lead

Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.

HOUR

Medical Claim Analyst

Outstanding communication skills to convey technical concepts clearly, concisely, and accurately to both technical and non-technical stakeholders. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Senior Salesforce Software Development Engineer

The Senior Software Developer will develop modular Python-based analytical applications and supporting software, contribute to differential privacy and disclosure-avoidance tools, build evaluation applications, support production analytical pipelines and automated output generation, develop dashboards and technical tools, ensure reproducibility and scalability, and support documentation, testing, training, and Government knowledge transfer. E-Logic, Inc. is seeking a Senior Software Developer to support the development, testing, implementation, validation, and optimization of software applications and analytical tools supporting the IRS RAAS Statistics of Income (SOI) Division's production of differentially private Qualified Opportunity Zone statistics.

E Logic

Senior Software Developer

The Hire Talent

Our portfolio of brands includes Oldcastle APG, Oldcastle Infrastructure, Belgard® hardscape, Echelon® Masonry, RDI® railing, Catalyst Fence Solutions, Sakrete® packaged concrete, Amerimix® mortar, Pebble Technology International® pool finishes, and Techniseal® sands and sealant technologies. We're a trusted and strategic partner to engineers, contractors, distributors, specifiers, retailers, and homeowners alike as the manufacturer of precast concrete, polymer concrete, and plastic infrastructure products.

Coding Manager Jobs in Little Rock, AR

Patient Safety DRG Clinical Validation Auditor Elevance Health

Autism Services Navigator TriWest Healthcare Alliance

Clinical - Quality Improvement Specialist (HEDIS) - 112274 Mindlance

Supervisor, Utilization Management TriWest Healthcare Alliance

AR Specialist | Physician Billing TIS International (USA) Inc

Executive Assistant (open to remote) Reinsurance Group of America Inc

Patient Care Coordinator Lyon College

Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health Corp

Claims Analyst/Adjuster (Little Rock AR or Enid, OK) Triangle Insurance

Utilization Clinical Reviewer TriWest Healthcare Alliance

Data Platform Engineer III (HEDIS Support) Cambia Health Solutions Inc

Data Platform Engineer III (Hedis Support) Cambia Health

Program Integrity Investigator TriWest Healthcare Alliance

Staff Software Development Engineer - iOS CVS Health Corp

Senior Lead Engineer PricewaterhouseCoopers LLP

Application Delivery Technical Lead Old Dominion Freight Line Inc

Medical Claim Analyst CVS Health Corp

Senior Salesforce Software Development Engineer CVS Health Corp

Senior Software Developer E Logic

Staff Accountant (Entry Level) OLDCASTLE APG, INC.

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