Familiarity with Milliman and InterQual guidelines. In-depth knowledge of current standard of medical practices. Strong knowledge of case-management processes. Detailed knowledge and competency in all types of medical-necessity decisions. Strong nursing expertise in managing patients.
Must be able to: Review medical record documentation in HPF/MPF, Create and assign to the necessary provider(s) dictation, signature and missing text deficiencies. Actively manages the various analysis specific work queues. Required Skills: 1 year experience in an office environment.
A transcription services company has an open position for a Telecommute Medical Scribe. Candidates will be responsible for the following: Listening to and documenting patient encounters. Updating the electronic medical record with pertinent, well-written medical history, physical examination.
Conduct clinical reviews of medical records. Process and/or review claims in a timely manner. Document clinical review findings within case tracking system. Required Skills: RN required, with related clinical review experience. Minimum of 5 years clinical experience.
Abstracting medical record documentation. Ensuring accurate code assignment in support of guidelines. Analyzing, entering and manipulating database. Required Skills: CPC or CCS Certification. 3+ years work experience. 6+ months medical coding and 6 months general clerical experience.
Perform collection follow up on accounts for medical facilities. Utilize excellent communication and customer service skills to resolve balances. Meet monthly goals and quality standards. Required Skills: Able to work Monday-Thursday 1:00pm-10:00pm and Friday 12:30pm-9:30pm.
Knowledge of official guidelines for coding and reporting. Knowledge of MS-DRGs and reimbursement methods for Medicare, CHAMPUS, Medicaid, other payers. Familiar with charge master and use of CDM for reference. Knowledge of medical terminology, anatomy, physiology, and pharmacology.
Demonstrating understanding of use of all Medical Necessity software. Composing clinical appeal letters. Qualifications for this position include: Demonstrates proficiency in Microsoft Office applications and others as required.
Must be able to: Conduct coding reviews of medical records. Process and/or review claims in a timely manner. Document coding review findings within investigative case tracking system. Required Skills: 3+ years’ experience in coding with primary focus in facility and pro fee coding.
A healthcare company has a current position open for a Remote Senior Medical Director. Individual must be able to fulfill the following responsibilities: Lead Physician team in efficient performance of daily activities. Participate with CMO as directed in client meetings.