NewMedical Scribe Oak Street HealthMedical ScribeCleveland, OH$17–$28.46Scribes receive extensive on-the-job training in clinical workflows, value-based medicine, preventative care for chronic conditions, accurate and specific documentation, population health data streams, and team based care. This is an excellent opportunity for pre-med track individuals looking to gain practical, paid experience in a clinical setting before applying to an MD/DO/PA/NP program, as well as those pursuing careers in Health Informatics, Public Health, Healthcare Administration, Medical Coding, and other related fields.
Coding Specialist-AR Management (Prof) MetroHealthCoding Specialist-AR Management (Prof)Cleveland, OHPreferred: Associate's Degree in Health Care Administration or a related field, or at least one year of experience with professional Fee-For-Service (FFS) coding in a hospital/physician's billing office. Comprehensive understanding of the Health Care Financing Administration (HFCA) billing practices, and health care issues effecting billing and reimbursement.
NewRemote Outpatient Coding Lead - ICD-10/CPT Expert Akron Children's HospitalRemote Outpatient Coding Lead - ICD-10/CPT ExpertAkron, OHRemoteAkron Children's Hospital seeks a Full-time Health Information Management Outpatient Coding Lead Specialist to facilitate reimbursement and data collection. The ideal candidate should have an associate degree in health information or related field, AHIMA or AAPC certification, and at least two years of coding experience.
Coding Supervisor Ensemble Health PartnersCoding SupervisorOHRemote$57,400–$86,100 / yearExperience We Love: 3 years of coding experience in either pro-fee or acute care setting to include inpatients, outpatients, and emergency department records or provider coding. Thorough working knowledge of coding classification systems to include Diagnosis Related Groups, (DRGs) and All Patient Refined - Diagnosis Related Groups, (APR-DRGs.).
Medical Coding Specialist Ensemble Health PartnersMedical Coding SpecialistOHRemote$20.45–$24.70 / hourRemain abreast of current requirements of the Centers for Medicare & Medicaid Services, (CMS) to include National Coverage Determinations, (NCD) and Local Coverage Determinations, (LCD) guidelines, related to the assignment of modifiers, to ensure the submission of a clean claim the first time through. We are seeking candidates with experience in multiple pro-fee specialties: Hem/Onc, Interventional Radiology, CVTS, Ortho, Podiatry, Wound Care, Rad/ONC, General Surgery, Allergy and ENT, OBGYN, Radiology and Urology.
Professional Coding Fee Analyst Dayton Children's HospitalProfessional Coding Fee AnalystOHJob Details: Ensures the accuracy, efficiency, and maximum financial return of Dayton Children''s professional billing claims for reimbursement. Ensures billing compliance; maintains knowledge of CPT and ICD-10 coding guidelines, as well as Medicare/Medicaid billing rules and regulations.
Physician Coding Auditor Ensemble Health PartnersPhysician Coding AuditorOHRemote$57,400–$99,000 / yearThe Physician Coding Auditor develops and implements strategic needs analyses and training plans for coding leadership; coordinates and evaluates curriculum development and conducts the preparation and delivery of training for Medical Coders employed by Ensemble and providers that are contracted/employed and outlined in the client SOW. Educating - Assesses the educational needs of coding staff and providers that are contracted/employed and outlined in the client SOW (included Provider Education verbiage) and develops programs or researches educational resources to meet those needs.
Epic Resolute Application Developer (Charge Router and Coding Skills) - 6260321 Accenture PlcEpic Resolute Application Developer (Charge Router and Coding Skills) - 6260321Cleveland, OHIn addition to delivering innovative solutions for Accenture's clients, you will work with a highly skilled, diverse network of people across Accenture businesses who are using the latest emerging technologies to address today's biggest business challenges. Dropping orders using chart review-> creating new patient encounter -> dropping an order and signing the order/Unite charge entry ->creating new encounter.
HIM Coder-Coding Services (DRG); 80hrs Biweekly Days MetroHealthHIM Coder-Coding Services (DRG); 80hrs Biweekly DaysCleveland, OHb>Analyzes clinical information in the inpatient medical record and translates into diagnosis and procedure codes for the most appropriate Diagnosis Related Group (DRG), Present on Admission (POA), Patient Safety (PSI) indicators, Severity of Illness (SOI), and Risk of Mortality (ROM ) scores for the purpose of hospital reimbursement, research and compliance with federal regulations. Assigns ICD-10-CM/PCS codes and abstracts pertinent data to ensure completeness, accuracy and compliance with established guidelines of all governmental regulatory agencies and third party payers.
Coding Educator Ensemble Health PartnersCoding EducatorOHRemote$62,500–$119,700 / yearPlan, develop, and present educational opportunities for workflow enhancements, clinical documentation improvement, coding and billing regulatory issues, charging processes, and other related revenue cycle trends. Experience We Love: 5 + years of coding and educational experience in Professional Fee Coding or consulting setting with preference for Cardiology, General Surgery, Neurosurgery or Ob GYN specialties.
Managed Services - Revenue Cycle Coding - Senior Manager PricewaterhouseCoopers LLPManaged Services - Revenue Cycle Coding - Senior ManagerOH$124,000–$280,000 / yearPwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy. As a Senior Manager, you will leverage your skills and influence to deliver quality results, motivate and coach teams to solve complex problems, and apply sound judgment to recognize when to take action or escalate issues.
NewCoding Tutors (Instant) Varsity Tutors, a Nerdy CompanyCoding Tutors (Instant)Cleveland, OHAbout Varsity Tutors and Instant TutoringOur mission is to transform the way people learn by leveraging advanced technology, AI, and the latest in learning science to create personalized learning experiences. As an Instant Tutor on the Varsity Tutors Platform, you'll have the flexibility to accept on-demand tutoring requests whenever you're available, earn competitive rates, and make a real impact by helping students in the moment they need it most—all from the comfort of your home.
General Practice Care - Associate Veterinarian - North Ridgeville , {State_Code UsvtaGeneral Practice Care - Associate Veterinarian - North Ridgeville , {State_CodeNorth Ridgeville, OhioAn exceptional veterinary hospital, with a dedicated team, is seeking an Associate Veterinarian to provide superior patient and client care to members of its community. of rewards and benefits that our partners may offer, but the specific details surrounding each hospital’s total rewards package will be provided by the hiring manager during each interview process.
Dentist (Job Code: AL0212) Smile Brands Group IncDentist (Job Code: AL0212)Cleveland, OH$75,712–$180,000 / weekAt Bright Now Dental, supported by Smile Brands, youll join a community of collaborative providers who are invested in growing their skills, building strong patient relationships, and creating a culture where everyone smiles. Veteran Careers: If you are active duty and seeking off-duty employment or a separated/retired military specialist looking to join a new team, we welcome a conversation.
Dentist (Job Code: AL0212) Bright Now! DentalDentist (Job Code: AL0212)Cleveland, Ohio$75,712–$180,000 / weekSmile Brands supports over 650 affiliated dental practices across 28 states all focused on a single mission of delivering Smiles For Everyone!® Smiles for patients, providers, employees, and community partners. Overview: At Bright Now Dental , supported by Smile Brands, you'll join a community of collaborative providers who are invested in growing their skills, building strong patient relationships, and creating a culture where everyone smiles.
Medical Billing Assistant - Entry Level VitalsearchgroupMedical Billing Assistant - Entry LevelCleveland, OhioThe Medical Billing Assistant will help prepare and review insurance claims, assist with basic billing and coding tasks, update patient and insurance information, and support the administrative workflows that help keep clinical operations running smoothly. This person should be comfortable learning billing and coding processes, communicating with patients professionally, and maintaining accuracy when working with claims, records, and confidential information.
Billing Specialist 838031 StiversBilling Specialist 838031Mayfield Heights, OHAs a Medical Billing Specialist, youll be responsible for managing insurance verification, submitting claims, following up on unpaid accounts, and handling denial appeals. If you're ready to start a rewarding career as a Medical Billing Specialist in Mayfield Heights, apply today or contact our recruiting team to learn more.
Hospital Billing Coordinator Deloitte Touche Tohmatsu LtdHospital Billing CoordinatorOH$50,000–$60,000 / yearOur purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities. This compensation range is specific to the remote role and takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs.
Remote PB Medical Coder - Neurology Clinic GuidehouseRemote PB Medical Coder - Neurology ClinicAkron, OhioRemoteCompensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs. The Remote Neurology Clinic Coder reviews clinical documentation and diagnostic results to assign accurate ICD-10, CPT, and HCPCS codes for billing, reporting, and compliance.
Medical Biller - Part-time Area TempsMedical Biller - Part-timeParma, OHWe have an immediate opening for a Medical Biller who will be responsible for managing patient billing processes, ensuring accurate claim submissions, and facilitating communication between healthcare providers, patients, and insurance companies. Analyze and address denied claims by identifying reasons for denial, appealing decisions when appropriate, and implementing corrective actions to prevent future denials .
NewBilling Analyst - Patient Accounts Revenue Cycle SummaCare IncBilling Analyst - Patient Accounts Revenue CycleAkron, OH$19.23–$23.08 / hourExceptional candidates gravitate to Summa because of its culture, passion for delivering excellent service to our patients and families commitment to our philosophy of servant leadership, collegial working relationships at every level of the organization and competitive pay and benefits. Summary: Submits billing to specific payers for services rendered accurately, timely, and in compliance with federal, state, and payer specific regulations.
Remote PB Medical Coder - Neurology Clinic Guidehouse IncRemote PB Medical Coder - Neurology ClinicAkron, OHRemote$38,000–$64,000 / yearCompensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs. What You Will Do: The Remote Neurology Clinic Coder reviews clinical documentation and diagnostic results to assign accurate ICD-10, CPT, and HCPCS codes for billing, reporting, and compliance.
Patient Financial Advocate Firstsource Solutions LtdPatient Financial AdvocateEuclid, OHThe Patient Financial Advocate is responsible for screening patients on-site at hospitals for eligibility assistance programs either bedside or in the ER. Essential Duties and Responsibilities: Review the hospital census or utilize established referral method to identify self-pay patients consistently throughout the day.
Hospital Billing Operator Deloitte Touche Tohmatsu LtdHospital Billing OperatorOH$70,000–$90,000 / yearOur purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities. This compensation range is specific to the remote role and takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs.
Denials Systems Analyst-AR Management (Hosp) MetroHealthDenials Systems Analyst-AR Management (Hosp)Cleveland, OHProvides comprehensive support for all denial management functions by conducting root-cause analysis of denied claims, recommending corrective actions, and driving process improvements to reduce future denials. Ensures efficient and effective business office operations through continuous monitoring of workflows, identifying process gaps, and analyzing opportunities for operational improvement while maintaining awareness of current industry best practices.
Certified Coder Special Investigations Unit SIU SummaCare IncCertified Coder Special Investigations Unit SIUAkron, OH$28.10–$42.15 / hourSummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2026 by the Centers for Medicare and Medicaid Services (CMS). Maintain excellent working knowledge of process improvement techniques, methodologies and principles applying these in the normal course of operations.
NewCoder - Remote ProMedica Health System IncCoder - RemoteOHRemote$41,200–$61,360 / yearThe organization employs over 1,300 health care providers through ProMedica Physicians and has more than 2,300 physicians and advanced practice providers with privileges. Associate's or bachelor's degree in HIT/HIM OR High school diploma AND Certificate of Completion of AHIMA Coding Basics Program and Coding Assessment and Training Solutions Program.
Revenue Cycle Systems Analyst Crystal Clinic Orthopaedic CenterRevenue Cycle Systems AnalystAkron, OHWhat You'll Do: Responsible for supporting, optimizing, and maintaining revenue cycle and Electronic Medical Records (EMR) systems impacting patient access, charging, coding, billing, claims processing, reimbursement, and collections. Serves as the liaison between Revenue Cycle operations, Health Information Management (HIM), Information Technology (IT), clinical departments, and external vendors to support system performance, workflow optimization, and financial outcomes.
NewRevenue Cycle Systems Analyst Mt. Washington Pediatric HospitalRevenue Cycle Systems AnalystAkron, OH$54,000–$83,000 / yearLocation 3925 Embassy Parkway,Akron, OH, 44333,United StatesBase Pay $54,000.00 - $83,000.00 / YearJob Category Revenue CycleEmployee Type Exempt - FTThe EssentialsSchedule: Full-Time (40 hrs/week) | 1 st Shift | ExemptLocation: Fairlawn, OHSpecialties: Revenue Cycle, Healthcare Billing Cycle, EMR SystemsWhat You'll DoResponsible for supporting, optimizing, and maintaining revenue cycle and Electronic Medical Records (EMR) systems impacting patient access, charging, coding, billing, claims processing, reimbursement, and collections. Serves as the liaison between Revenue Cycle operations, Health Information Management (HIM), Information Technology (IT), clinical departments, and external vendors to support system performance, workflow optimization, and financial outcomes.
Financial Counselor I Midwest Vision PartnersFinancial Counselor IStow, OHFull timeAlpine is a strong supporter of MVP, given their PeopleFirst philosophy, unparalleled track record, significant financial resources, and a commitment to building a platform that includes physician leadership at the highest levels. The Financial Counselor is responsible for creating patient financial responsibility forms, entering patient owed amounts in the practice management system, and collection of patient financial responsibility prior to surgery, all in well planned and timely fashion.
Patient Financial Services Representative Centers for Dialysis CarePatient Financial Services RepresentativeShaker Heights, OHFull timeCenters for Dialysis Care is seeking an experienced Patient Financial Services Representative to work out of our Corporate Office located in Shaker Heights, OH. This includes root cause analysis, contact with payers (via phone or paper/electronic status inquires), ensuring patient responsibility is properly and timely identified.
Health Information Management (HIM) Intern Crystal Clinic Orthopaedic CenterHealth Information Management (HIM) InternAkron, OHExperience: Some college healthcare classes preferred; must possess knowledge of office equipment and excellent computer skills; critical thinking skills to process tasks accurately; must be organized and detail oriented; demonstrated problem solving and detailed oriented skills required. What We're Looking For: Education: Currently enrolled in an accredited associate or bachelor's degree program in Health Information Management, Health Information Technology, Healthcare Administration, Health Sciences, Public Health, Health Informatics, Business Administration, Medical Office Administration, or another closely related healthcare or business field.
NewBilling Supervisor Ensemble Health PartnersBilling SupervisorOHRemote$52,100–$65,125 / yearThe Supervisor will work with multiple disciplinaries including but not limited to Patient Access, Coding, Follow Up, Denials and any additional Revenue Management departments needed to aid in effort to ensure timely account review related to unbilled workflow. Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups.
Technical Business Analyst - Healthcare Billing Quadax, Inc.Technical Business Analyst - Healthcare BillingMiddleburg Heights, OH$85,000–$95,000 / yearPart timeThis role will serve as a critical link between business stakeholders and IT, ensuring that billing processes are optimized, compliant, and aligned with organizational goals. We are seeking a detail-oriented and technically proficient Technical Business Analyst with expertise in healthcare billing systems to join our team.
Senior Revenue Integrity Analyst Dayton Children's HospitalSenior Revenue Integrity AnalystOHThe senior revenue integrity analyst works accounts in assigned Revenue Integrity work queues to facilitate accurate, compliant billing of patient accounts and assists revenue integrity analysts with completion of tasks and work queues. Job Details: The senior revenue integrity analyst is responsible for planning and oversight of the revenue integrity analysts' performance of essential department accountabilities, including reporting to department leadership about goal status.
NewQuality Senior Analyst CVS Health CorpQuality Senior AnalystOH$46,988–$112,200 / yearResponsible for conducting complex audits, reviews and assessments of medical records coded by internal teams prior to the submission to the Centers of 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. Serves as the training resource and subject matter expert to vendors, providers and other team members for questions regarding ICD coding and documentation requirements.
Insurance Representative EverStaffInsurance RepresentativeMiddleburg Heights, OHYou will be responsible for following up on outstanding claims, resolving insurance and patient balance issues, and ensuring accurate reimbursement through effective communication, research, and problem?solving. Communicate with insurance payers and patients to address claim rejections and unpaid balances.
Allied Health Adjunct Professor Bryant & Stratton CollegeAllied Health Adjunct ProfessorParma, OHQualifications: Minimum of Master's degree in allied health (i.e MBA with Healthcare focus, MSN, or MD, DO, DC or in related field such as OT, PT, Medical lab technologists, Clinical Lab tech, respiratory therapists, and speech language pathologists, heath care administration with a clinical background). Founded in 1854, Bryant & Stratton College offers real-world education leading to bachelors, associates, and professional certificates after completion in the fields of healthcare, technology, legal, business, graphic design, and more.
Allied Health Adjunct Professor Bryant & StrattonAllied Health Adjunct ProfessorParma, OHTeach 3-14 contact hours in Medical Assisting or Health Services Administration classes based on qualifications and college need (4 campus locations in area) + Facilitate student progress in achieving theory and performance requirements of the program, including CMA pass rates + Assist in developing and utilize instructional plans, course blueprints, and business connects + Participate in campus events + Develop, implement, and assess strategies and techniques for improved student retention and success + Ensure instructional success and model lifelong learning through continuous professional development + Complete and maintain a teaching portfolio **Qualifications:** + Minimum of Master’s degree in allied health (i.e MBA with Healthcare focus, MSN, or MD, DO, DC or in related field such as OT, PT, Medical lab technologists, Clinical Lab tech, respiratory therapists, and speech language pathologists, heath care administration with a clinical background) + Current or be eligible for a nationally-recognized field certification such as CMA, RMA, RN, DO, DC, JD, MD, DVM, RT) + Successful work experience required in clinic, medical office, or laboratory setting involving clinical skills + Faculty wishing to teach medical office procedures or healthcare reimbursement must possess a billing and coding certification such as CMRS, CPC, CPC-H, CCS, CCS-P, RHIT, or RHIA + Effective in directing and evaluating student learning and laboratory performance + Teaching experience or aptitude preferred + Working knowledge of computer software and research databases + Demonstrated commitment to professional development and student success + Commitment to continuous curriculum enhancement and application of best practices + Strong team player + Ability to make meaningful and positive connections with diverse student body in a career college environment Apply online at: careers.bryantstratton.edu Founded in 1854, Bryant & Stratton College offers real-world education leading to bachelor's, associate's, and professional certificates after completion in the fields of healthcare, technology, legal, business, graphic design, and more.
Technical Business Analyst - Healthcare Billing Quadax Careers & CultureTechnical Business Analyst - Healthcare BillingMiddleburg Heights, OhioThis role will serve as a critical link between business stakeholders and IT, ensuring that billing processes are optimized, compliant, and aligned with organizational goals. We are seeking a detail-oriented and technically proficient Technical Business Analyst with expertise in healthcare billing systems to join our team.
Dialysis Clinical Manager Registered Nurse - RN Fresenius Medical CareDialysis Clinical Manager Registered Nurse - RNAkron, OhioOther: • Collaborates closely with, providing oversight as needed to, the Clinical Manager/Charge RN acting as nurse manager, the Medical Director, and the physicians regarding the direct patient care responsibilities within the facility to ensure the provision of outstanding quality of patient care, as defined by the FMS quality goals, and compliance with the pertinent company policies and procedures. • Demonstrated leadership competencies and management skills for the position, including excellent communication, customer service, continuous quality improvement, relationship development, results orientation, team building, motivating employees, performance management and decision making.
Supervisor, Claims A/R Signature Health IncSupervisor, Claims A/ROHThe Supervisor, Claims A/R oversees payer related functions, including provider enrollment, insurance account analysis, denial resolution, and payment posting, and ensures that staff are equipped with the knowledge, tools, and guidance needed to perform at a high level. Demonstrated ability to oversee daily team operations and maintain alignment with departmental goals, consistent with the requirement to oversee the daily objectives of the Billing & Claims team, ensuring efficiency and accuracy.
Medical Billing Specialist - Westlake Achievement Centers for ChildrenMedical Billing Specialist - WestlakeWestlake, OHThis role is ideal for someone who enjoys detail-oriented work, understands healthcare billing processes, and can balance professionalism with empathy when addressing billing questions. Achievement Centers for Children is a Cleveland, Ohio based nonprofit that is nationally recognized for helping children with disabilities and their families achieve and thrive.
Medical Scribe CVS Health CorpMedical ScribeCleveland, OH$17–$28.46 / hourScribes receive extensive on-the-job training in clinical workflows, value-based medicine, preventative care for chronic conditions, accurate and specific documentation, population health data streams, and team based care. This is an excellent opportunity for pre-med track individuals looking to gain practical, paid experience in a clinical setting before applying to an MD/DO/PA/NP program, as well as those pursuing careers in Health Informatics, Public Health, Healthcare Administration, Medical Coding, and other related fields.
Coder III - Remote ProMedica Health System IncCoder III - RemoteOHRemote$45,968–$72,488 / yearThe organization employs over 1,300 health care providers through ProMedica Physicians and has more than 2,300 physicians and advanced practice providers with privileges. Associate's or bachelor's degree in HIT/HIM OR High school diploma AND Certificate of Completion of AHIMA Coding Basics Program and Coding Assessment and Training Solutions Program.
NewMedical Assistant Intern - Med Assistant Training Program (Paid), Parma, 80 hours MetroHealthMedical Assistant Intern - Med Assistant Training Program (Paid), Parma, 80 hoursCleveland, OHAcquires the knowledge, skills, and abilities related to Medical Terminology, Health Care Law and Ethics, Pharmacology, Anatomy and Physiology, Clinical and Laboratory Procedures, Medical Office procedures including Electronic Health Record documentation, and billing and coding. Acquires knowledge and experience needed to assist in supporting the team in the delivery of high value patient care to infants through geriatric patient populations.
NewPatient Navigator HealogicsPatient NavigatorWestlake, OhioLearn more about this role here: Healogics is the largest provider of advanced wound care services in the United States, treating more than 300,000 chronic wound patients annually across over 600 sites. All Healogics employees must perform their job responsibilities according to all Healogics policies, Hospital policies, as well as to accrediting organizations, federal and state regulation, and to the Centers for Medicare and Medicaid Services (CMS) guidelines, as applicable.
Coder Quality Auditor Ensemble Health PartnersCoder Quality AuditorOHRemote$57,400–$99,000 / yearReporting - Provides reports of audit findings to coding management, individual coders and leadership as needed/requested along with providers that are contracted/employed and outlined in the client SOW. Required Certifications: Candidates must have and keep current at least one of the following professional certifications (CPC, CPMA or CCS Preferred): CPC (Certified Professional Coder).
Hospice Account Executive - Cleveland, OH UnitedHealth Group IncHospice Account Executive - Cleveland, OHCleveland, OHPrimary Responsibilities Build and maintain relationships with target referral sources to execute the bring care to more people growth strategy Implement manage and document consistent sales activities with multiple contacts in each referral source Seek to better understand the needs of customers to provide customized solutions and earn newcontinued referrals Expand the healthcare communitys use of our services by supporting knowledge and awareness of our solutions Serve as a liaison between our referral sources community our patientsfamilies facing end of life care and our agencies Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide. Clinical ›Corporate and business operations ›Customer and support services ›Early careers›Sales and account management ›Technology and data›Physicians›Advanced practice clinicians›Pharmacy›Behavioral health›Nursing›Medical coding›Clinical support›U.S.
Manager, Clinical Payment Integrity Medical MutualManager, Clinical Payment IntegrityCleveland, OhioManages vendor relationships specific to clinical coding and claims payment audits, ensuring adherence to contractual limits, validating alignment between vendor deliverables and internal MMO activities to avoid duplication, and assessing cost effectiveness to ensure maximum value from vendor services. Provides leadership and oversight for the Clinical Review & Recovery teams to strengthen the effectiveness of the clinical coding and claims payment auditing program and provides clinical coding and clinical review expertise for the Medical Policy and Clinical teams.