UNKNOWN

FEED

Identifies trends in provider coding/documentation and vendor risk adjustment reporting and makes those trends known to leadership as well as coding team manager and training lead to develop intervention strategies - all in service of creating a person-focused health care experience. As a member of the Risk Adjustment team, our The Risk Adjustment Auditor performs Retrospective/Prospective chart review utilizing various types of records to ensure accurate risk adjustment reporting.

HOUR

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

QA Risk ADj Auditor II

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Cambia Health

QA Risk Adj Auditor II

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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.

YEAR

<p>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. </p>

CVS Health Corp

Senior Investigator, Special Investigations Unit (Aetna SIU)

The CDS utilizes the hospital's designated clinical documentation system to identify opportunities for physician and hospital outcomes, provides or coordinates education to all internal customers related to compliance, coding, and clinical documentation issues and acts as a consultant to coders when additional information or documentation is needed to assign the correct diagnosis related group (DRG). Graduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).

Sanford Health

RN Clinical Documentation Specialist

RN - Clinical Documentation Specialist

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FULL_TIME

OTHER

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.

TriWest Healthcare Alliance

Utilization Clinical Reviewer

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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.

Data Platform Engineer III (Hedis Support)

Data Platform Engineer III (HEDIS Support)

What You Will Do at Cambia: Collaborate closely with Provider Services, Network Management, corporate business support, operations staff and others to ensure negotiated provider and institutional payments are implemented correctly and promptly. As a member of the Provider Reimbursement team, our Pricing and Reimbursement Analysts analyze, develop, and maintain contract payment terms and reimbursement rates for institutional, facility, and professional healthcare providers across all regions and Regence subsidiaries.

Pricing Reimbursement Analyst I Or II

Pricing Reimbursement Analyst I or II

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

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

The Architect also leads the team's adoption of AI-driven development, applying the AI-Driven Development Life Cycle (AI-DLC), large language models (LLMs), and AI coding agents to accelerate delivery while maintaining architectural quality and human oversight. About Harris Computer: Harris provides mission critical software solutions for the Public Sector, Healthcare, Utilities and Private Sector verticals throughout North America, Europe, Asia and Australia.

Harris Computer Systems

Software Architect

Preference will be given to current employees and candidates who reside within a commutable distance from our Salt Lake City, Boise, Fargo, Lewiston, Little Rock and Springdale offices or who are willing to relocate. What You Bring to Cambia: Qualifications: The Facets Developer II would have a Bachelor's degree in Computer Science, Mathematics, Business Administration, Engineering, or a related field and at least 3 years relevant experience in a multi-platform environment.

Facets Developer II Or III (Facets Application Services)

What You Bring to Cambia: Qualifications: The Software Development Engineer II would have a Bachelor's degree in Computer Science, Mathematics, Business Administration, Engineering, or a related field and at least 3 years relevant experience in a multi-platform environment. The Software Development Engineer III would have a Bachelor's degree in Computer Science, Mathematics, Business Administration, Engineering, or a related field and at least 5 years relevant experience in a multi-platform environment.

Software Development Engineer II - III (EDI Enrollment)

Preference will be given to current employees and candidates who reside within a commutable distance from our Salt Lake City, Boise, Fargo, Lewiston, Little Rock and Springdale offices or who are willing to relocate. What You Bring to Cambia: Qualifications: The Software Development Engineer II would have a Bachelor's degree in Computer Science, Mathematics, Business Administration, Engineering, or a related field and at least 3 years relevant experience in a multi-platform environment.

Software Development Engineer II - III (Edi Enrollment)

What You Bring to Cambia: Qualifications: The Facets Developer II would have a Bachelor's degree in Computer Science, Mathematics, Business Administration, Engineering, or a related field and at least 3 years relevant experience in a multi-platform environment. Preference will be given to current employees and candidates who reside within a commutable distance from our Salt Lake City, Boise, Fargo and Lewiston offices or who are willing to relocate.

Facets Developer II or III (Facets Application Services)

This leader will collaborate with data management to utilize predictive and prescriptive analytics to stratify our beneficiary population for inclusion in multiple Medical Management programs; direct staff and interventions that will improve beneficiary health outcomes including HEDIS scores; develop and implement clinical programs to optimize Condition/Disease Management strategies and goals; and collaborate with leadership to enhance the overall healthcare education and knowledge of our beneficiaries using multiple platforms and experiences. Technical Skills: Advanced knowledge of managed care principles; working knowledge of medical necessity review criteria, LOS, ICD, CPT, HCPCs and American Dental Coding required; quality management training/experience; extensive experience with relational databases and statistical analysis.

Director, Population Health

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.

Coding Manager Jobs in North Dakota

QA Risk ADj Auditor II Cambia Health Solutions Inc

QA Risk Adj Auditor II Cambia Health

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

RN Clinical Documentation Specialist Sanford Health

RN - Clinical Documentation Specialist Sanford Health

Utilization Clinical Reviewer TriWest Healthcare Alliance

Data Platform Engineer III (Hedis Support) Cambia Health

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

Pricing Reimbursement Analyst I Or II Cambia Health

Pricing Reimbursement Analyst I or II Cambia Health Solutions Inc

Program Integrity Investigator TriWest Healthcare Alliance

Staff Software Development Engineer - iOS CVS Health Corp

Application Delivery Technical Lead Old Dominion Freight Line Inc

Software Architect Harris Computer Systems

Facets Developer II Or III (Facets Application Services) Cambia Health

Software Development Engineer II - III (EDI Enrollment) Cambia Health Solutions Inc

Software Development Engineer II - III (Edi Enrollment) Cambia Health

Facets Developer II or III (Facets Application Services) Cambia Health Solutions Inc

Director, Population Health TriWest Healthcare Alliance

Senior Software Developer E Logic

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