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We are looking for a meticulous and analytical Payment Integrity Auditor to ensure accurate claims payment, uphold compliance with regulatory standards, and drive financial integrity through detailed chart reviews and collaborative audit processes." Responsibilities: 1. Perform medical chart reviews to ensure provider billing adherence to medical policies and claims payment policies. 2. Review inpatient charts to validate DRG assignment based on ICD-10-CM and ICD-10-PCS coding. 3. Ensure compliance with CMS guidelines, payer policies, and official coding rules. 4. Perform Readmission audits to identify related admissions per claims payment policy criteria. 5. Provide detailed clinical and coding rationale to support audit findings. 6. Collaborate with Providers and Medical Directors to resolve audit disputes. 7. Initiate, verify, and reconcile claim adjustments. Maintain audit documentation. 8. Perform other duties of the Payment Integrity Auditor as required. Qualifications: 1. Bachelor's degree in a health care-related field or business-related discipline preferred. 2. Current credentials of CPC, RN, or RHIT/RHIA/CCS. 3. Strong knowledge of medical terminology and ICD-10-CM/PCS coding guidelines. 4. Understanding of Inpatient Prospective Payment System (IPPS), MSDRG, and regulatory requirements and/or Outpatient Prospective Payment System (OPPS). 5. Inpatient Medical Chart Review experience is required....Phlebotomist at Providence Health and Services summary: The Phlebotomist position at Providence Sacred Heart Medical Center involves collecting and processing laboratory specimens from various hospital departments. Responsibilities include specimen collection, maintaining...
...A local municipality is seeking a Public Safety Ambassador in Marietta, Georgia. This role involves responding to low-risk calls for service, documenting incidents through reports, and performing various administrative duties that may include traffic direction and evidence...
...preferred. Ability to handle client inquiries with professionalism, patience, and empathy. Familiarity with CRM software (e.g., Zendesk, Salesforce) is a plus. Excellent problem-solving skills and a solutions-oriented mindset. Reliable, organized, and able to...
Job Description \n \n\n\n Senior Compliance Analyst \n \n Work Mode:Onsite \n \n Location: Onsite, four days per week Kohler, WI Opportunity The Senior Compliance Analyst is a key member of the Employment and Compliance team, reporting directly to the...
OB/GYN needed for a private practice in Miami!! If is a growing practice, 6 OB/GYN's plus APP's. Has a medical Spa as well as the OB/GYN work. He is in the process of building a third office which will have an REI lab as well as a procedure room. CONTACT: Anna ...