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... 60%. Territory includes: U pstate New York, Vermont, Maine, and New Hampshire Responsibilities will include: Identify, ... clinical/scientific information and opportunities to internal stakeholders. Provide scientific support at .....
Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g. CPT) to patient records. The Medical Coding Auditor ..
... (VCE) for the Department of Medicine. The successful candidate will lead ... will represent the Department of Medicine on the Albany Medical College ... liaison between the Chair of..
... and determinations, clinical reference materials, internal teaching conferences, and other reference ... work, communication of decisions to internal associates, and possible participation in ... such as MCG® or InterQual..
Description The Director, Pharmacy Clinical Formulary and Medical Drug Strategies oversees and drives the pharmacy and medical drug formulary strategies across all lines of business (Medicare, Commercial, Medicaid). This position will ..
... and determinations, clinical reference materials, internal teaching conferences, and other reference ... work, communication of decisions to internal associates, and possible participation in ... as directed. This is a..
Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part C Line of Business. The Medical Director provides medical interpretation and determinations ..
Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..
Job Information Humana AVP, Stars and Risk Adjustment National Medical Director in Albany New York Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking a talented Physician executive that ..
Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical Coding ..
Description The Behavioral Health Medical Director makes determinations regarding prior authorization and retrospective reviews for inpatient and outpatient services to ensure that members receive clinically appropriate and medically necessary services. All ..
... federal regulations as well as internal policies and guidelines. Works within ... to a week at a time Collaborates with provider offices through ... holiday, one day of volunteer..
Description The Medical Coding Coordinator 2 will process and apply the appropriate Code Edit claim payment reductions and denials based on software recommendation. The Medical Coding Coordinator 2 reviews submitted medical ..
Description The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately complex to complex issues where the analysis of ..
... and determinations, clinical reference materials, internal teaching conferences, and other sources ... work, communication of decisions to internal associates, and possible participation in ... such as MCG® or InterQual..
Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health episodic and per diem requests. The Medical Director provides medical interpretation and determinations whether ..
Description The Medical Coding Coordinator 3 extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical ..
... experience and knowledge of both medicine and social determinants of health. ... and determinations, clinical reference materials, internal teaching conferences, and other reference ... work, communication of decisions to..
Description The Manager, Medical Coding oversees the coding team that is reviewing inpatient records for appropriate coding to include ICD-10, CPT, and HCPCS. The Manager, Medical Coding works within specific guidelines ..
