Medical Claims/Billing Specialist Integrated Resources, IncMedical Claims/Billing SpecialistMASON, OHUtilize a practice EHR system and clearing house to review and submit claims to multiple medical insurance carriers Review open/unpaid claim balances and take required action. Partner with the clearing house to distribute patient billing statements and monitor the patient portal to post payments in the EHR system.
Medical Biller Abacus Service CorporationMedical BillerMASON, OHBy applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from and its affiliates, and contracted partners. Join our dynamic team at the Cincinnati Service Center where you'll play a crucial role in ensuring the smooth processing of medical claims.
Office/Administration - Medical Claims Coordinator/Processor MindlanceOffice/Administration - Medical Claims Coordinator/ProcessorMASON, OHUtilize a practice EHR system and clearing house to review and submit claims to multiple medical insurance carriers Review open/unpaid claim balances and take required action. " Partner with the clearing house to distribute patient billing statements and monitor the patient portal to post payments in the EHR system.
Senior Consultant - Clinical Documentation Specialist Deloitte Touche Tohmatsu LtdSenior Consultant - Clinical Documentation SpecialistCincinnati, OH$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.
Prior Authorization Specialist Riverhills NeurosciencePrior Authorization SpecialistCincinnati, OH$18–$22 / hourFull timeYour responsibilities include:Streamline pre-certification, authorization, and referral processes, ensuring compliance with insurance requirementsCoordinate with insurance entities, review organizations, and clinical contacts for effective communication and benefit determinationFacilitate peer-to-peer reviews for escalated encounters and address inquiries from providers, staff, and patientsEnsure timely and accurate insurance authorizations, conduct medical benefits investigations, and manage authorizations for botulinum toxin proceduresMonitor schedules for insurance coverage changes, oversee specialty pharmacy orders, and maintain/update the ordering spreadsheetInitiate patient education on available assistance programsBackground and Experience:1-2 years of relevant experience in medical billing and/or prior authorization within a healthcare practicePain Management experience is a plusExperience with an Electronic Medical Record (EMR) and practice management systemKnowledge of Medicare/Medicaid and major insurance carrier's guidelinesWorking knowledge of ICD-9-10 medical coding and billing and medical terminologySuperior verbal and written skills are a must, as are sound judgement, maturity, and the ability to establish good rapport with employees, patients, physicians, and vendorsIf you're eager to contribute to a world-class healthcare team, apply today. Our commitment to excellence extends across diagnosis, education, and treatment for those facing nervous system diseases and injuries.
Financial Operations Analyst Lead - Payment Integrity Datamining Elevance Health IncFinancial Operations Analyst Lead - Payment Integrity DataminingMason, OHMinimum Requirements: Requires a BA/BS in accounting or finance and a minimum of 5 years' experience in a finance/health insurance field capacity and experience with relational databases and mainframe and client server report writers; or any combination of education and experience, which would provide an equivalent background. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
DRG Clinical Auditor Principal (US) Elevance Health IncDRG Clinical Auditor Principal (US)Mason, OHSpecializes in review of DRG coding via medical record and attending physician's statement provided by acute care hospitals on paid DRG, especially on very complex coding cases that are paid using APS-DRG, APR-DRG, AP-DRG, MS-DRG or TRICARE methodology and findings may be so complex and advanced that disputes or appeals may only be reviewed by other DRG Coding Audit Principals (or Executives). The DRG Clinical Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients.
NewFollow Up and Billing Rep St. Elizabeth HealthcareFollow Up and Billing RepEdgewood, KYDemonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background. Demonstrates adequate, appropriate, and professional levels of communication with insurance company representatives, team members, supervisors, and managers.
NewFollow Up and Billing Rep SEH Saint Elizabeth Medical CenterFollow Up and Billing RepEdgewood, KentuckyDemonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background. Demonstrates adequate, appropriate, and professional levels of communication with insurance company representatives, team members, supervisors, and managers.
Medical Claims Biller Onsite GlobalchannelmanagementMedical Claims Biller OnsiteMason, OhioPartner with the clearing house to distribute patient billing statements and monitor the patient portal to post payments in the EHR system. The Medical Claims Biller is responsible for monitoring insurance carrier adjudication of medical claims for one or more doctor practices.
Clinical Auditor Principal (Rhia,Rhit,Ccs Or Cic)- RN Preferred Elevance HealthClinical Auditor Principal (Rhia,Rhit,Ccs Or Cic)- RN PreferredMason, OH$122,240–$183,360 / yearSpecializes in review of DRG coding via medical record and attending physician's statement provided by acute care hospitals on paid DRG, especially on very complex coding cases that are paid using APS-DRG, APR-DRG, AP-DRG, MS-DRG or TRICARE methodology and findings may be so complex and advanced that disputes or appeals may only be reviewed by other DRG Coding Audit Principals (or Executives). The Clinical Auditor Principal (RHIA,RHIT,CCS or CIC)- RN Preferred is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients.
Clinical Auditor Principal (RHIA,RHIT,CCS or CIC)- RN Preferred Elevance HealthClinical Auditor Principal (RHIA,RHIT,CCS or CIC)- RN PreferredMason, Ohio$122,240–$183,360 / yearSpecializes in review of DRG coding via medical record and attending physician’s statement provided by acute care hospitals on paid DRG, especially on very complex coding cases that are paid using APS-DRG, APR-DRG, AP-DRG, MS-DRG or TRICARE methodology and findings may be so complex and advanced that disputes or appeals may only be reviewed by other DRG Coding Audit Principals (or Executives). The Clinical Auditor Principal (RHIA,RHIT,CCS or CIC)- RN Preferred is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all lines of business, and its clients.
Prior Authorization Specialist Riverhills Healthcare IncPrior Authorization SpecialistCincinnati, OH$18–$22 / hourSuperior verbal and written skills are a must, as are sound judgement, maturity, and the ability to establish good rapport with employees, patients, physicians, and vendors. Monitor schedules for insurance coverage changes, oversee specialty pharmacy orders, and maintain/update the ordering spreadsheet.
Patient Financial Advocate Firstsource Solutions LtdPatient Financial AdvocateCincinnati, 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.
Executive Case Manager (Remote) ValerisExecutive Case Manager (Remote)Cincinnati, OhioRemoteBacked by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Personalized Case Management Provides personalized case management to patients and HCPs including outbound communication to HCPs, specialty pharmacies and patients to communicate benefit coverage and/or appropriately help drive next steps in obtaining coverage and/or access to prescribed medicine.
Facility Clinical Documentation Specialist TriHealth IncFacility Clinical Documentation SpecialistCincinnati, OHRegistered Nurse or Licensed Practical Nurse, or Registered Health Information Administrator, or Registered Health Information Technician, ACDIS - Association of Clinical Documentation Integrity Specialists credential, or Certified Professional Coder, Certified Outpatient Coder, Or Certified Documentation Expert Outpatient. Job Overview: The Facility Outpatient Clinical Documentation Specialist (CDS) is responsible for activities which assist the organization with processes for complete and accurate capture of documentation and charges in a compliant manner for the outpatient services rendered.
Prior Authorization and Medical Records Coordinator- Outpatient Behavioral Health TriHealth IncPrior Authorization and Medical Records Coordinator- Outpatient Behavioral HealthCincinnati, OHThe Prior Authorization and Medical Records Specialist is responsible for obtaining and managing insurance authorizations to support timely patient access to services within various Behavioral Health programs, including partial hospitalization (PHP), intensive outpatient program for addiction (IOP), neuropsychology, and psychiatric medication management practices. Job Overview: This position provides both direct patient care in a primary care office and works with care delivery providers to identify gaps in care, contacts patients to schedule required care, and provides referral follow up.
Medical Assistant/ Medical Home Coordinator TriHealth IncMedical Assistant/ Medical Home CoordinatorHamilton, OHUnderstands adult and/or pediatric preventive medicine schedules, including wellness visits, vitals, labs, immunizations, screening tools, and patient education; identifies and communicates care gaps, utilization, and chronic disease needs. Provides accurate and complete documentation of rooming information, clinical calls, orders, pending prescriptions, pharmacy updates, and workflow tasks; addresses phone and MyChart messages promptly and escalates issues as needed.
Licensed Practical Nurse/Medical Home Coordinator TriHealth IncLicensed Practical Nurse/Medical Home CoordinatorLebanon, OHJob Overview: This position provides both direct and indirect patient care in a primary care office and works with care delivery providers to identify gaps in care, contacts patients to schedule required care, and provides referral follow up. Documents all aspects of care accurately, including clinical calls, rooming questions, procedures, orders, prescriptions, pharmacy coordination, and workflow tasks; manages MyChart and patient messages in a timely manner.
MEDICAL ASSISTANT/MEDICAL HOME COORDINATOR TriHealth IncMEDICAL ASSISTANT/MEDICAL HOME COORDINATORMason, OHJob Overview: This position provides both direct patient care in a primary care office and works with care delivery providers to identify gaps in care, contacts patients to schedule required care, and provides referral follow up. Provides accurate/complete documentation of clinical calls and patient rooming info as well as order entry, pending prescriptions, noting current pharmacy, and enter edit workflows to result orders.