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Adaptive Home Health
Overview
The Home Health Quality Assurance Registered Nurse is responsible for coding, reviewing, validating, and correcting OASIS assessments to ensure clinical accuracy, regulatory compliance, and optimal reimbursement. This role involves supporting agency performance by improving documentation quality, reducing payment risk, and ensuring adherence to CMS, Medicare, and payer guidelines.
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Compensation
$35 / HOUR
Posted
11 days ago
Crossing Rivers Health
The Medical Coding and Prior Authorization Specialist is responsible for coding patient encounters and managing prior authorization processes. This role ensures compliance, maximizes reimbursement, and facilitates timely access to necessary medical care for patients.
Salary not listed
1 month ago
HCR Home Care
The RN Case Manager administers skilled nursing care, teaches and supervises the nursing team and family, and is responsible for the overall plan of care and achieving positive patient outcomes efficiently.
$80,000 - $90,000 / YEAR
Grace Health
The QI Nurse evaluates clinical documentation and conducts chart audits to ensure compliance with regulatory and payer requirements. They coordinate health plan submissions and collaborate with clinical teams to improve patient outcomes and documentation practices.
Hennepin Healthcare
The Utilization Review Registered Nurse evaluates the medical necessity, appropriateness, and efficiency of healthcare services using established criteria like InterQual. This role collaborates with clinical teams, payers, and patients to optimize resource utilization and ensure quality care progression.
2 months ago
Prisma Health
The professional is responsible for abstracting and validating CPT, ICD-10, and HCPCS codes across inpatient, outpatient, and physician's office settings while adhering to all coding and compliance guidelines. Essential functions include abstracting/coding based on documentation, utilizing appropriate coding resources, resolving pre-billing edits, and providing feedback to providers to clarify coding concerns.
FULGENT THERAPEUTICS LLC
The Genetic Counselor Assistant will support licensed genetic counselors within the Benefits Investigation division by assisting in the review of patient cases and handling administrative tasks necessary for insurance coverage of NGS testing. This includes coordinating with clinicians and partners to obtain required information for prior authorization and coverage decisions.
Easterseals MORC
This role is responsible for facilitating the enrollment of new providers to ensure timely billing and collections by preparing and processing enrollment applications for various health plans, including Medicare and Medicaid. Key duties involve maintaining accurate provider data, managing required documentation like licensure and insurance, and ensuring adherence to all enrollment timelines and departmental policies.
The RN Case Manager administers skilled nursing care, teaches and supervises the nursing team, and is responsible for the overall plan of care and achieving positive patient outcomes efficiently. Essential functions include conducting comprehensive patient assessments, developing and implementing nursing care plans, and overseeing care provided by Home Health Aides.
$74,000 - $85,000 / YEAR
Physicians’ Primary Care
The coder will review provider documentation to assign accurate ICD-10 CM, CPT, and HCPCS codes, ensuring alignment with payer guidelines and identifying chronic conditions via HCC Risk Adjustment coding. Responsibilities also include communicating with providers about documentation gaps, assisting with claim denials, and staying current on coding updates.
MyMichigan Health
This position is responsible for coding all services, including major and minor surgical cases performed in office and hospital settings, ensuring compliance with third-party payer guidelines for maximum reimbursement. Responsibilities include coding visits and services within 48 hours of receipt and utilizing coding guidelines to ensure clean claims.
Premier Medical Resources
The specialist verifies patient insurance coverage for surgeries and procedures, creates cost estimates, and ensures financial clearance by updating accurate benefit information in the Electronic Medical Records (EMR). Essential functions include resolving coverage issues, serving as a liaison between parties, and calculating patient financial responsibilities per payer contracts.
3 months ago
Wilmington Health PLLC
The specialist serves as a charge capture and professional coding expert, reviewing medical documentation to ensure accurate assignment of diagnosis and procedure codes (CPT, HCPCS Level II, ICD-10-CM) for claims processing and data retrieval. This role involves working independently to meet productivity standards while collaborating with practitioners to clarify coding details and supporting billing/customer service departments with related inquiries.
Hartford HealthCare
The role is responsible for scheduling hospital-based surgeries according to physician orders and insurance mandates, ensuring all pre-operative requirements are met and communicating instructions to patients. Additionally, the scheduler must reconcile dropped charges against authorized procedures and maintain accurate documentation within EPIC regarding insurance authorizations.
The RN Case Manager will administer skilled nursing care, teach and supervise the family and nursing team, and coordinate quality patient care while maintaining productivity and achieving positive patient outcomes. Responsibilities include conducting admissions, developing and implementing the nursing care plan, and overseeing care provided by Home Health Aides.
$80,000 - $95,000 / YEAR
Monument Health
Pharmacy Specialists perform duties to ensure appropriate medication delivery and access for patients, often performing pharmacy technician duties up to the limit of their certification. Responsibilities vary based on the setting, including specialty pharmacy, infusion, or medication access environments.
$21 - $27 / HOUR
Access Healthcare Staffing & Recruitment
The Clinical Documentation Coordinator conducts concurrent reviews of inpatient medical records to ensure accurate, complete, and compliant documentation. They collaborate with physicians, coding, and quality teams to improve clinical documentation metrics and support appropriate reimbursement and risk adjustment.
$39 - $61 / HOUR
4 months ago
The RN Case Manager administers skilled nursing care, teaches and supervises the nursing team, and is responsible for the overall plan of care and achieving positive patient outcomes efficiently. This includes conducting comprehensive patient assessments, developing care plans, and overseeing the services provided by Home Health Aides.
Indiana Regional Medical Center
The specialist will be responsible for verifying patient insurance eligibility, benefits, and authorization requirements before or during services, and obtaining necessary initial and continued insurance authorizations for inpatient stays. This role also involves communicating coverage details and financial obligations to patients and staff, and ensuring medical documentation aligns with payer guidelines.
5 months ago
