NewCertified Professional Coder, Special Investigations Unit (Aetna SIU) CVS Health CorpCertified Professional Coder, Special Investigations Unit (Aetna SIU)AR$43,888–$102,081 / yearThe Certified Professional Coder (CPC) will perform medical claim reviews to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
Medical Billing and Coding Specialist Apex StaffingMedical Billing and Coding SpecialistLittle Rock, ArkansasAccurately abstracts data and codes ambulatory surgery center procedures for reimbursement using ICD-10, CPT, and other applicable patient classification schemes. Medical Billing and Coding Certification with successful completion of medical terminology, anatomy, physiology, and coding courses in ICD-10-CM and CPT-4 preferred.
NewCoding Auditor - Ambulatory/Professional Coding/Profee Huron Consulting GroupCoding Auditor - Ambulatory/Professional Coding/ProfeeKentucky, AR$26.44–$52.40 / hourPHYSICAL DEMANDS: This role requires remaining seated at a desk/computer for 8 hours daily; repetitive use of computer keyboard and mouse; use of computer monitors for 8 hours daily; interaction though video/audio conference calls and possible use of a headset with microphone; very rarely duties might require the ability to lift up to 20 pounds and bending & standing for periods at a time. Demonstrates knowledge of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS) or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous documentation.
Patient Safety DRG Clinical Validation Auditor Elevance HealthPatient Safety DRG Clinical Validation AuditorKentucky, AR$86,560–$129,840 / yearPreferred skills, qualifications and experiences: One or more of the following certifications are preferred: Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background.
Senior Clinical Coding Analyst TriWest Healthcare AllianceSenior Clinical Coding AnalystLittle Rock, ARRemoteFull timeIndependent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources. Conducts retrospective medical claims review for coding and pricing determinations and/or coding review for inpatient (facility) claims to include diagnosis and procedural coding with DRG assignment.
Charge Master Analyst Sutter HealthCharge Master AnalystLittle Rock, AR$106,745.60–$160,118.40 / yearPosition Overview: Serves as a subject matter expert for Charge Description Master (CDM) regulatory requirements and guidelines and payer contractual obligations in order to ensure CDM line items are aligned with current billing, coding regulations, guidelines, and contractual obligations. Maintains the CDM data elements (billing description, Current Procedural Terminology/Healthcare Procedure Coding System codes, revenue codes for Inpatient/Outpatient and appropriate modifiers) in the CDM software.
Inpatient Coding Auditor Huron Consulting GroupInpatient Coding AuditorKentucky, ARRemote$38.46–$52.40 / hourPHYSICAL DEMANDS: This role requires remaining seated at a desk/computer for 8 hours daily; repetitive use of computer keyboard and mouse; use of computer monitors for 8 hours daily; interaction though video/audio conference calls and possible use of a headset with microphone; very rarely duties might require the ability to lift up to 20 pounds and bending & standing for periods at a time. Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes (ICD-PCS), MS-DRG, APR DRG, POA, SOI & ROM assignments.
Program Integrity Investigator TriWest Healthcare AllianceProgram Integrity InvestigatorLittle Rock, ARRemoteFull timeComplies 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 (Healthcare Fraud Waste & Abuse) TriWest Healthcare AllianceProgram Integrity Investigator (Healthcare Fraud Waste & Abuse)Little Rock, ARRemoteFull timeComplies 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 Clinical Spc TriWest Healthcare AllianceProgram Integrity Clinical SpcLittle Rock, ARRemoteFull 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.
Audit and Billing Compliance Specialist University Of Arkansas SystemAudit and Billing Compliance SpecialistLittle Rock, ARPerforms specific audits outside the audit plan schedule as needed (to include, but not limited to, Office of Inspector General (OIG) audits, Medicare Administrative Contractor (MAC) audits, Recovery Audit Contractor (RAC) audits, Medicaid Integrity Contractor (MIC) audits, etc.). Department's Website: Summary of Job Duties: The Audit & Billing Compliance Specialist works under the general direction of the Clinical Billing Compliance Director and reviews medical records and billing system programs to determine coding and billing accuracy and to ensure that all federal and state guidelines for coding and billing are followed.
NewAudit and Billing Compliance Specialist University of ArkansasAudit and Billing Compliance SpecialistLittle Rock, ArkansasPerforms specific audits outside the audit plan schedule as needed (to include, but not limited to, Office of Inspector General (OIG) audits, Medicare Administrative Contractor (MAC) audits, Recovery Audit Contractor (RAC) audits, Medicaid Integrity Contractor (MIC) audits, etc.). The Audit & Billing Compliance Specialist works under the general direction of the Clinical Billing Compliance Director and reviews medical records and billing system programs to determine coding and billing accuracy and to ensure that all federal and state guidelines for coding and billing are followed.
Claims Coordinator State of ArkansasClaims CoordinatorLittle Rock, AR$57,351–$84,879 / yearPerform basic to intermediate claims data analysis, including filtering and aggregating large datasets, identifying trends and outliers, comparing provider billing patterns, calculating financial impacts, and developing audit samples. As a result of Governor Hutchinson's Transformation of State Agencies, the Department of Inspector General was created by joining together the Office of Internal Audit, the Fair Housing Commission, and the Office of Medicaid Inspector General.
CLAIMS COORDINATOR State of ArkansasCLAIMS COORDINATORLittle Rock, AR$57,351–$84,879 / yearPerform basic to intermediate claims data analysis, including filtering and aggregating large datasets, identifying trends and outliers, comparing provider billing patterns, calculating financial impacts, and developing audit samples. As a result of Governor Hutchinson's Transformation of State Agencies, the Department of Inspector General was created by joining together the Office of Internal Audit, the Fair Housing Commission, and the Office of Medicaid Inspector General.