NewFamily Nurse Practitioner / Physician Assistant - Growth Opportunity Fast Pace HealthFamily Nurse Practitioner / Physician Assistant - Growth OpportunityGreenbrier, TNPosting Title: Family Nurse Practitioner / Physician Assistant Overview: In a manner consistent and supportive of our values, the Provider is responsible for delivering high quality health care within Fast Pace Health’s scope of services while achieving optimum patient satisfaction. They must have the ability to respond quickly and accurately to changes in condition or response to treatment and is responsible for providing outstanding patient service within the clinic and through various virtual communication channels, while maintaining a compassionate and welcome atmosphere.
NewFamily Nurse Practitioner / Physician Assistant - Flexible Schedules Fast Pace HealthFamily Nurse Practitioner / Physician Assistant - Flexible SchedulesGreenbrier, TNPosting Title: Family Nurse Practitioner / Physician Assistant Overview: In a manner consistent and supportive of our values, the Provider is responsible for delivering high quality health care within Fast Pace Health’s scope of services while achieving optimum patient satisfaction. They must have the ability to respond quickly and accurately to changes in condition or response to treatment and is responsible for providing outstanding patient service within the clinic and through various virtual communication channels, while maintaining a compassionate and welcome atmosphere.
Medicare Risk Adjustment Coding Specialist- Remote American Health PlansMedicare Risk Adjustment Coding Specialist- RemoteFranklin, TNRemoteFull timeReview medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries to verify accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered. • Maintain a high level of familiarity of current CMS regulations and announcements affecting risk adjustment to include the review of regulatory announcements via educational sessions provided by regulatory entities and educational opportunities within the industry.
Senior Coding Specialist (Gastroenterology Procedure Coding exp required) - REMOTE Vanderbilt University Medical CenterSenior Coding Specialist (Gastroenterology Procedure Coding exp required) - REMOTENashville, TennesseeRemoteCertified Coding Associate - American Health Information Management Association (AHIMA), Certified Coding Specialist - American Health Information Management Association (AHIMA), Certified Coding Specialist - Physician - American Health Information Management Association (AHIMA), Certified Outpatient Coder - American Academy of Professional Coders, Certified Professional Coder - Outpatient - American Academy of Professional Coders, Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA), Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA) Work Experience: Demonstrate advanced knowledge and expertise in professional and outpatient facility coding practices; provide guidance and support to coding staff on complex coding scenarios and regulatory requirements; stay updated on changes in coding regulations and guidelines to maintain subject matter expertise.
Remote Coding Quality Education Review Specialist ($5k sign on bonus!) LifePoint Health IncRemote Coding Quality Education Review Specialist ($5k sign on bonus!)Brentwood, TNRemoteCertifications: Certified Coding Specialist (CCS), Certified Coding Specialist - Physician (CCS-P), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC), or other comparable nationally recognized acute care coding credential provided through AHIMA or AAPC. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities.
Coding Specialist (Cardiology E/M Coding exp required) - REMOTE Vanderbilt University Medical CenterCoding Specialist (Cardiology E/M Coding exp required) - REMOTENashville, TNRemotePosition Qualifications: Responsibilities: Certifications: Certified Coding Associate - American Health Information Management Association (AHIMA), Certified Coding Specialist - American Health Information Management Association (AHIMA), Certified Coding Specialist - Physician - American Health Information Management Association (AHIMA), Certified Outpatient Coder - American Academy of Professional Coders, Certified Professional Coder - Outpatient - American Academy of Professional Coders, Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA), Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA). Discover Vanderbilt University Medical Center: Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world.
Senior Coding Specialist (Ortho Coding exp required) - REMOTE Vanderbilt University Medical CenterSenior Coding Specialist (Ortho Coding exp required) - REMOTENashville, TNRemotePosition Qualifications: Responsibilities: Certifications: Certified Coding Associate - American Health Information Management Association (AHIMA), Certified Coding Specialist - American Health Information Management Association (AHIMA), Certified Coding Specialist - Physician - American Health Information Management Association (AHIMA), Certified Outpatient Coder - American Academy of Professional Coders, Certified Professional Coder - Outpatient - American Academy of Professional Coders, Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA), Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA). Demonstrate advanced knowledge and expertise in professional and outpatient facility coding practices; provide guidance and support to coding staff on complex coding scenarios and regulatory requirements; stay updated on changes in coding regulations and guidelines to maintain subject matter expertise.
Coding and Medical Records Auditor American Health Companies IncCoding and Medical Records AuditorFranklin, TNAssist with validation audits to evaluate medical record documentation to ensure coding accurately reflects and supports relevant coding based on the ICD-10 code submitted to CMS and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions applicable to Medicare Risk Adjustment reimbursement initiatives. Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries as needed to verify and ensure the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered.
Senior Coding Specialist (Plastic Surgery exp required) - REMOTE Vanderbilt University Medical CenterSenior Coding Specialist (Plastic Surgery exp required) - REMOTENashville, TennesseeRemoteCertified Coding Associate - American Health Information Management Association (AHIMA), Certified Coding Specialist - American Health Information Management Association (AHIMA), Certified Coding Specialist - Physician - American Health Information Management Association (AHIMA), Certified Outpatient Coder - American Academy of Professional Coders, Certified Professional Coder - Outpatient - American Academy of Professional Coders, Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA), Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA) Work Experience: Demonstrate advanced knowledge and expertise in professional and outpatient facility coding practices; provide guidance and support to coding staff on complex coding scenarios and regulatory requirements; stay updated on changes in coding regulations and guidelines to maintain subject matter expertise.
Remote Inpatient Coding Specialist (Join Our Team and Earn a $5,000 Sign-On Bonus!) LifePoint Health IncRemote Inpatient Coding Specialist (Join Our Team and Earn a $5,000 Sign-On Bonus!)Brentwood, TNRemoteAs an Inpatient Coding Specialist, you will be responsible for Assigning diagnosis and procedure codes using the appropriate coding classification system on all episodes of care inpatient encounters according to coding conventions, guidelines, and hospital policy, analyzing questionable documentation to ensure the accuracy of the information and resolve identified issues. A Inpatient Coding Specialist who excels in this role: Assign appropriate diagnosis and procedure codes utilizing ICD 10-CM/PCS codes according to the Centers for Medicare & Medicaid Services (CMS) requirements for hospital billing.
Senior Coding Specialist, PRN (Inpatient Coding exp required) - REMOTE Vanderbilt University Medical CenterSenior Coding Specialist, PRN (Inpatient Coding exp required) - REMOTENashville, TNRemoteDiscover Vanderbilt University Medical Center: Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more.
Internal and Family Medicine - Certified Coding Specialist - Full Time Murfreesboro Medical Clinic PAInternal and Family Medicine - Certified Coding Specialist - Full TimeMurfreesboro, TNThis role ensures proper assignment of CPT, ICD-10, and HCPCS codes in compliance with CMS guidelines and supports accurate billing, reimbursement, and regulatory adherence while collaborating with providers and administrative staff. The Certified Professional Coder (CPC) / Uncertified Coder is responsible for reviewing, researching, and accurately coding office, surgical, and procedural documentation.
Coding Quality Reviewer RightWorksCoding Quality ReviewerNashville, TennesseeYou will perform internal quality assessment reviews on Health Information Management Service Center(HSC) coders to ensure compliance with national coding guidelines, the HSC coding policies and the Company coding policies for complete, accurate and consistent coding which result in appropriate reimbursement and data integrity. Lead, coordinate and perform all functions of quality reviews (routine, pre-bill, policy driven and incentive plan driven)for inpatient and outpatient coding across multiple HSCs.
Outpatient Coding Specialist - Surgery (Remote) LifePoint Health IncOutpatient Coding Specialist - Surgery (Remote)Brentwood, TNRemoteAssign diagnosis and procedure codes using the appropriate coding classification system on all episodes of care in the emergency department, same-day surgery, outpatient clinic, observation, inpatient OB/newborn hospital, specialty clinic encounters according to coding conventions, guidelines, and hospital policy, analyzing questionable documentation to ensure to the accuracy of the information and resolve identified issues. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities.
NewCoding Data Quality Auditor CVS Health CorpCoding Data Quality AuditorTN$18.50–$38.82 / hourResponsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures. Proficient in abstraction and assignment of accurate medical codes for diagnoses as documented by physicians and other qualified healthcare providers in the office and/or facility setting.
Coding Quality Auditor Houston Methodist HospitalCoding Quality AuditorTNHouston Methodist also includes a research institute; a comprehensive residency program; international patient services; freestanding comprehensive care clinics, emergency care and imaging centers; and outpatient facilities. The health system consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the Texas Medical Center, seven community hospitals and one long-term acute care hospital throughout the Greater Houston metropolitan area.
NewCoding Quality Reviewer Team Lead HCA Healthcare IncCoding Quality Reviewer Team LeadNashville, TNAssists in the development, Maintenance, and Distribution of Operational and Outcome ReportingOther duties as assignedGenerating reports as needed by Coding Quality ManagementOversee Coding Quality reviews from review scope definition, account selection, data loading, reviews, appeals and final outcomes reportingReconciling CQR & HSC/CCRM appeal responses Prepares meeting minutesEnsures coverage for essential tasks between normal working hours Qualifications: Undergraduate degree in HIM/HIT required2-years of equivalent HIM/HIT work experience may substitute degree requirementManagement/Supervisory experience in healthcare related field preferredMinimum of 5 years acute care inpatient/outpatient coding experience requiredMinimum of 5 years coding auditing/monitoring experience requiredRHIA, RHIT and/or CCS required Benefits Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing.
NewVendor Resource Management Profee Coding Manager HCA HealthcareVendor Resource Management Profee Coding ManagerNashville, TNThe VRM Pro-Fee Manager ensures Vendor inventory is monitored daily; ensures queue concerns or resource changes are communicated to CCU as needed; ensures coder productivity and daily/weekly/monthly completion volumes are tracked and monitored. The VRM Pro-Fee Manager plans, assigns and directs the coding workflow between Vendors and CCU; actively monitors employee and vendor performance; addresses complaints and resolves problems; and actively monitors production and quality control efforts.
Senior Compliance Coding Auditor Wellpath IncSenior Compliance Coding AuditorFranklin, TNTuition Assistance and dependent Scholarships• Employee Assistance Program (EAP) including free counseling and health coaching• Company paid life insurance• Tax free Health Spending Accounts (HSA)• Wellness program featuring fitness memberships and product discounts• Preferred banking partnership and discounted rates for home and auto loans. Demonstrated experience performing complex E/M, primary care, chronic disease management, behavioral health, and/or medication-assisted treatment (MAT) audits using AMA CPT, ICD-10-CM, HCPCS, and CMS guidance.
WVUH - Professional Coding Auditor-Educator West Virginia University MedicineWVUH - Professional Coding Auditor-EducatorTNCertification in ONE of the following: Registered Health Information Administrator (RHIA) OR Registered Health Information Technician (RHIT) through American Health Information Management Association) Certified Outpatient Coder (COC) through American Academy of Professional Coders Certified Coding Specialist (CCS) through American Health Information Management Association Certified Professional Coder (CPC) through American Academy of Professional Coders. EXPERIENCE: Extensive experience in ICD-10-CM, ICD-10-PCS, CPT, and MS-DRG, HCC and APR-DRG assignment for Positions and multi-specialty coding, E&M coding, procedural/surgical coding, as well as knowledge of governmental billing and coding regulations including the "Teaching Physician Guidelines" for Professional Coding Positions preferred.
Medical Billing Specialist - Remote Medbridge HealthcareMedical Billing Specialist - RemoteBrentwood, TNRemoteThe successful candidate will be highly organized, detail-oriented, and comfortable working directly with insurance carriers, patient accounts, and reimbursement processes to ensure timely and accurate payment for services rendered. The Medical Billing Specialist is responsible for the daily execution of billing and accounts receivable activities, including claim submission, payment posting, insurance follow-up, denial management, collections, and account resolution.
Manager of Coding Operations Quorum Health CorporateManager of Coding OperationsBrentwood, TennesseeRemoteDemonstrates extensive knowledge of Official ICD-10-CM/PCS Coding Guidelines, UHDDS, MS-DRG and APR-DRG assignment methodologies, OPPS, IPPS, APC reimbursement methodologies, Coding Clinic, CPT Assistant, HCPCS Level II, Medicare Claims Processing Manual, Medicare Benefit Policy Manual, National Correct Coding Initiative (NCCI) edits, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and commercial payer coding and reimbursement requirements. Collaborates with facility leadership, Revenue Integrity, Patient Financial Services, Clinical Documentation Integrity (CDI), Charge Description Master (CDM), ancillary departments, and clinical leaders to resolve coding discrepancies, conflicting documentation, charge capture issues, HCPCS assignment questions, and reimbursement concerns.
Manager of Coding Operations Quorum Health CorpManager of Coding OperationsBrentwood, TNRemoteKnowledge, Skills and Abilities: Demonstrates extensive knowledge of Official ICD-10-CM/PCS Coding Guidelines, UHDDS, MS-DRG and APR-DRG assignment methodologies, OPPS, IPPS, APC reimbursement methodologies, Coding Clinic, CPT Assistant, HCPCS Level II, Medicare Claims Processing Manual, Medicare Benefit Policy Manual, National Correct Coding Initiative (NCCI) edits, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and commercial payer coding and reimbursement requirements. Collaborates with facility leadership, Revenue Integrity, Patient Financial Services, Clinical Documentation Integrity (CDI), Charge Description Master (CDM), ancillary departments, and clinical leaders to resolve coding discrepancies, conflicting documentation, charge capture issues, HCPCS assignment questions, and reimbursement concerns.
Patient Care Specialist (Medical Receptionist) Fast Pace HealthPatient Care Specialist (Medical Receptionist)Nashville, TennesseeFull timeMaintains the overall cleanliness of the office as needed to support the team and clinic environment, which may include, but not be limited to, taking out garbage, organization and cleanliness of desk, patient and office space and assistance with other team members to achieve a strong professional appearance for our employees, patients and visitors. Level 2: High School Diploma or its equivalent with a current CPR license* and 3 years’ experience in billing and coding and intermediate computer skills, which include typing 70-100 words per minute, knowledge of Microsoft Office including, word and excel.
Manager of Coding Operations 2822-QHC ARM Shared ServicesManager of Coding OperationsBrentwood, TNRemotePart timeDemonstrates extensive knowledge of Official ICD-10-CM/PCS Coding Guidelines, UHDDS, MS-DRG and APR-DRG assignment methodologies, OPPS, IPPS, APC reimbursement methodologies, Coding Clinic, CPT Assistant, HCPCS Level II, Medicare Claims Processing Manual, Medicare Benefit Policy Manual, National Correct Coding Initiative (NCCI) edits, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and commercial payer coding and reimbursement requirements. Collaborates with facility leadership, Revenue Integrity, Patient Financial Services, Clinical Documentation Integrity (CDI), Charge Description Master (CDM), ancillary departments, and clinical leaders to resolve coding discrepancies, conflicting documentation, charge capture issues, HCPCS assignment questions, and reimbursement concerns.
Medical Billing Specialist American Health Companies IncMedical Billing SpecialistFranklin, TNJOB SUMMARY: The Medical Billing Specialist for Nurse Practitioners is responsible for processing and mailing/transmitting claims, tracking claims, monitoring authorization and eligibility of payor benefits, managing the collections process and posting cash receipts. Receive and review Daily Reconciliation Review (DAR) document for accuracy; enter charges into Practice Management System (PMS).
Medical Office Specialist HCA Healthcare IncMedical Office SpecialistNashville, TNWhat Qualifications you will need: One to Three year s of experience in a medical office setting is preferred High School Diploma or GED Required Experience using an EHR system is highly preferred Experience working in specific specialty is preferred Benefits Southern Hills Cardiology, offers a total rewards package that supports the health, life, career and retirement of our colleagues. With a focus on meeting the needs of our patients at all access points, Physician Services is dedicated to implementing innovative, physician-driven, value-added solutions to assist physicians in providing high-quality, patient-centered care, aligning with our mission to care for and enhance human life.
Certified Coder/Billing Specialist WOMENS GROUP OF FRANKLIN PLLCCertified Coder/Billing SpecialistFranklin, TNInterested Candidates can fax resume to: 615-778-0715 Attn: Office Manager or e-mail resume to scannon@womensgroupfranklin.com. The ideal candidate will have strong knowledge of OB/GYN coding, CPT, ICD-10 and insurance guidelines and be able to work efficiently in a fast-paced medical office environment.
NewInpatient Audit Specialist FT DatavantInpatient Audit Specialist FTNashville, TNRemote$35–$45 / hourBy joining Datavant today, you're stepping onto a driven and highly collaborative team that is passionate about creating transformative change in healthcare.* 2,500 Sign on Bonus **As an Inpatient Auditing Specialist you will be instrumental in addressing consulting and educational needs related to coding quality, compliance assessments, external payer reviews, coding education, interim coding management, and coding workflow operations reviews. Systems: Cerner PowerChart, 3M360.What you will bring to the table:3+ years experience coding and auditingAssociate or Bachelor's degree from an AHIMA-certified HIM or Nursing Program, or completion of a certificate program from AAPC with a preference for CCSPreferred: CCS, RHIT, or RHIA credentials.
NewInpatient Audit Specialist FT- Sign on Bonus DatavantInpatient Audit Specialist FT- Sign on BonusNashville, TNRemote$35–$45 / hourAs an Inpatient Auditing Specialist you will be instrumental in addressing consulting and educational needs related to coding quality, compliance assessments, external payer reviews, coding education, interim coding management, and coding workflow operations reviews. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies.
Clinical Documentation Specialist 2822-QHC ARM Shared ServicesClinical Documentation SpecialistBrentwood, TNPart timeUtilizes critical thinking skills and clinical reasoning to identify, clarify, and query accurate representation of documentation to reflect appropriate clinical status of the patient which will translate into quality reporting, physician report cards, reimbursement, public health data, and disease tracking and trending. Applies knowledge of ICD-10-CM/PCS Official Guidelines for Coding and Reporting, AHA Coding Clinic, MS-DRG/APR-DRG methodology, CC/MCC capture, SOI/ROM, and quality indicators to support an accurate working DRG in collaboration with Coding/HIM.
Clinical Documentation Specialist Quorum Health CorporateClinical Documentation SpecialistBrentwood, TennesseeUtilizes critical thinking skills and clinical reasoning to identify, clarify, and query accurate representation of documentation to reflect appropriate clinical status of the patient which will translate into quality reporting, physician report cards, reimbursement, public health data, and disease tracking and trending. Applies knowledge of ICD-10-CM/PCS Official Guidelines for Coding and Reporting, AHA Coding Clinic, MS-DRG/APR-DRG methodology, CC/MCC capture, SOI/ROM, and quality indicators to support an accurate working DRG in collaboration with Coding/HIM.
Clinical Documentation Specialist Quorum Health CorpClinical Documentation SpecialistBrentwood, TNUtilizes critical thinking skills and clinical reasoning to identify, clarify, and query accurate representation of documentation to reflect appropriate clinical status of the patient which will translate into quality reporting, physician report cards, reimbursement, public health data, and disease tracking and trending. Applies knowledge of ICD-10-CM/PCS Official Guidelines for Coding and Reporting, AHA Coding Clinic, MS-DRG/APR-DRG methodology, CC/MCC capture, SOI/ROM, and quality indicators to support an accurate working DRG in collaboration with Coding/HIM.
Senior Consultant - Clinical Documentation Specialist Deloitte Touche Tohmatsu LtdSenior Consultant - Clinical Documentation SpecialistTN$110,700–$218,300 / yearOther skills include the ability to analyze, act and design action plans upon monthly and quarterly reports related to individual providers, facilities, MS-DRGs, APR, PSIs, severity of illness and risk of mortality, capture rates, quality metrics and can effectively prioritize their work activities. Clinical Payments Optimization: Assisting clients by validating that payments for clinical healthcare services comply with regulatory, clinical based evidence and contractual requirements while also determining that payments are appropriate for the type and level of care provided.
Network Medical Director - (Field-based /Remote) UnitedHealth Group IncNetwork Medical Director - (Field-based /Remote)Nashville, TNRemote$248,500–$373,000 / yearThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. Collaborates in teaching clinicians and clinical operations teams about Medicare Risk Adjustment, CMS STARs/HEDIS, and overall population health approach to patient care in both formal presentations and off the cuff at impromptu opportunities.
NewProFee Audit Specialist- FT DatavantProFee Audit Specialist- FTNashville, TNRemote$35–$45 / hourSign on BonusWhat We're Looking For: As a Profee Auditing Specialist, you will be instrumental in addressing consulting and educational needs related to coding quality, compliance assessments, external payer reviews, coding education, interim coding management, and coding workflow operations reviews. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies.
Remote Medical Biller SydieraRemote Medical BillerNashville, TennesseeRemoteThis role supports healthcare providers by helping manage insurance claims, patient billing, coding processes, and revenue cycle operations. Previous medical billing, medical coding, healthcare administration, or customer service experience is a plus but not required.
Program Integrity Clinical Specialist (RN or PA Req'd) TriWest Healthcare AllianceProgram Integrity Clinical Specialist (RN or PA Req'd)Nashville, TNRemoteFull timeTechnical Skills: Knowledge of TRICARE policies and procedures, knowledge of Case Management, Utilization Management, and Quality Management practices and principles, and knowledge of Managed Care concepts, alternative care treatments, and community resources. • Research and investigate medical issues as they relate to potential fraud and abuse cases, to include perform anti-fraud and abuse pre-payment reviews or post-payment reviews.
NewRemote Professional Fee Audit Specialist Flexible Schedule DatavantRemote Professional Fee Audit Specialist Flexible ScheduleNashville, TNRemoteDatavant is seeking a Professional Fee Auditing Specialist to perform coding audits and provide coder education in a fully remote and flexible environment. The ideal candidate will have over 5 years of coding and auditing experience, preferably with CPC certification.
NewSpecialist, Product Success Wellvana Health LLCSpecialist, Product SuccessNashville, TNClarity on the Role: As our Specialist, Product Success, you'll monitor and resolve Tier I support tickets, guide internal and external users through platform training, and keep partner data accurate across Salesforce and our proprietary systems. Our enlightened approach-covering everything from care coordination to clinical documentation education to marketing- ties the healthy outcomes of patients directly to shared savings for primary care providers, health systems and payors.
CENTRAL APPEALS SUPPORT SPECIALIST University Health Services IncCENTRAL APPEALS SUPPORT SPECIALISTBRENTWOOD, TNRemotePOSITION SUMMARY: Central Appeals Support Specialist This role is responsible for managing and supporting the behavioral health appeals process, including following up with insurance companies, refiling denied or underpaid claims, and maintaining detailed records of appeal outcomes. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.
Patient Advocate Specialist Firstsource Solutions LtdPatient Advocate SpecialistFranklin, TNOur Firstsource Solutions USA, LLC teams are with patients all the way, providing support and assistance all the while seeing first-hand the positive impact of their work through the emotions of relief and joy of the patients. At Firstsource Solutions USA, LLC, our employees are there for the moments that matter for customers as they navigate some of the biggest, most challenging, nerve-racking, and rewarding decisions of their lives.
Specialist, Clinical Documentation Improvement ArchWell Health LLCSpecialist, Clinical Documentation ImprovementNashville, TNThe CDIS functions as an expect source and educates members of the patient care team both formally and informally regarding the impact of documentation on patient care, quality metrics, (HCCs), and correct reimbursement. Provide both formal and informal education to physicians, advanced practice providers, and other key healthcare providers regarding clinical documentation updates and present chart review findings.
NewAccounts Receivable Specialist (2968) US Heart and VascularAccounts Receivable Specialist (2968)Franklin, TNUtilize clinical applications, payer websites and other systems as a research tool to retrieve medical documentation, patient eligibility information, billing guidelines, patient referrals, and hospital or procedure code authorizations to substantiate corrected claims submissions, through written appeals, and coding reviews, etc. Utilize clinical applications, payer websites and other systems as a research tool to retrieve medical documentation, patient eligibility information, billing guidelines, patient referrals, and hospital or procedure code authorizations to substantiate corrected claims submissions.
DRG Validation Specialist Nadia GruzdDRG Validation SpecialistNashville, TennesseeLeads, coordinates and performs all functions of quality reviews (routine, pre-bill, policy driven and incentive plan driven) for inpatient coding across multiple HSCs. Demonstrates and applies expert level knowledge of medical coding practices and concepts.
Medical Assistant Humana IncMedical AssistantTN$43,000–$56,200 / yearAs the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more.
Intake Specialist II TwelveStone Health PartnersIntake Specialist IIMurfreesboro, TNChronic conditions include Multiple Sclerosis, NMOSD, Myasthenia Gravis, CIDP, ITP, Migraine Prevention, Crohn's Disease, Ulcerative Colitis, Plaque Psoriasis, Alpha 1 Antitrypsin Deficiency, Primary Immunodeficiency, hATTR Amyloidosis, Thyroid Eye Disease, and many others. Verify insurance coverage to determine patient OOP, obtain documentation to ensure the product(s) are being ordered meet(s) insurance requirements, coordinate with authorization counterparts to ensure all information required by insurance is successfully authorized, dispense and bill medication.
Intake Specialist II Full-time - Murfreesboro, TN TwelveStone Health PartnersIntake Specialist II Full-time - Murfreesboro, TNMurfreesboro, TNChronic conditions include Multiple Sclerosis, NMOSD, Myasthenia Gravis, CIDP, ITP, Migraine Prevention, Crohn's Disease, Ulcerative Colitis, Plaque Psoriasis, Alpha 1 Antitrypsin Deficiency, Primary Immunodeficiency, hATTR Amyloidosis, Thyroid Eye Disease, and many others. Verify insurance coverage to determine patient OOP, obtain documentation to ensure the product(s) are being ordered meet(s) insurance requirements, coordinate with authorization counterparts to ensure all information required by insurance is successfully authorized, dispense and bill medication.
NewAppeals Specialist - Insurance / Revenue Cycle Sarasota Memorial HospitalAppeals Specialist - Insurance / Revenue CycleNashville, TNPosition HighlightsPrepare, submit, and track insurance appeals for denied or underpaid claimsReview EOBs and payer responses to identify root causes and develop effective appeal strategiesDraft clear, compliant appeal letters supported by medical documentation and codingMonitor appeal status and follow up with payers to ensure timely resolutionMaintain accurate records, logs, and reporting of appeal outcomes and trendsCollaborate with billing, coding, and clinical teams to resolve complex casesRequirements2+ years of experience in medical billing, insurance follow-up, or appealsStrong knowledge of denial management, payer guidelines, and appeals processesExperience reviewing EOBs, medical records, and coding (ICD-10/CPT preferred)Excellent written and verbal communication skillsHigh attention to detail, organization, and problem‑solving abilityProficiency in EMR/EHR systems and Microsoft OfficeBe the voice that turns denials into approvals—apply today.#J-18808-Ljbffr. Appeals Specialist – Insurance / Revenue CycleJoin a results‑driven revenue cycle team where your expertise in appeals and denial management directly impacts reimbursement and patient accounts.