Assists with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes.
Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes.
Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership.
Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote it one of the “Best Places to Work in PA”.
Utilizes technical coding expertise to assign appropriate ICD-10-CM and CPT-4 codes to outpatient visit types
Reviews the medical record thoroughly, utilizing all available documentation to code appropriate diagnoses and procedures.
Collaborates with Orders Management Unit (OMU) and other coding divisions for NCD/LCD edit resolution.
Northwestern Medicine is committed to cultivating a patient-first approach within a positive workplace and is a leader in the healthcare industry. They offer competitive benefits and aim to care for their employees during their quest for better healthcare.
The Director, MSSP Quality will lead cross-functional operational initiatives across Provider Networks and Product to ensure comprehensive data integrity and optimal performance in Quality reporting.
The Director will be responsible for managing and resolving field queries, preparing comprehensive reporting for executive and practice leadership, and formulating strategic initiatives for MSSP Quality programs across the organization.
The role requires strong leadership capabilities, analytical experience, and the ability to collaborate effectively with cross-functional teams while translating complex quality data into actionable insights that drive organizational excellence in MSSP Quality performance.
Aledade empowers independent primary care practices to deliver better care and thrive in value-based care. Founded in 2014, they are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Creates and delivers education to the Coding Team, Clinical Documentation Nurses, Physicians, and other licensed providers.
Collaborates with the CMOs to ensure the integrity of the Health Record is established through best practices in Clinical Documentation and Coding.
Communicates with Leadership across the regions to develop educational programs that address identified opportunities to improve clinical dashboard results.
Northwestern Medicine is a leader in the healthcare industry and is known for its patient-first approach, cultivating a positive workplace. They provide employees with competitive benefits, including tuition reimbursement, loan forgiveness, 401(k) matching, and lifecycle benefits.
Provides data management support services to Dignity Health’s CI/ACO Networks, Employer Relations and Valued Based Operations (VBO).
Within the Salesforce platform, this individual gathers and maintains accurate provider data, performs periodic provider data reconciliations with multiple data sources.
Maintains and transmits fee schedules, as necessary, to third-party administrators (TPA's) and other appropriate stakeholders.
Dignity Health MSO builds a system-wide integrated physician-centric, full-service management service organization structure. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers.
Manage clinical trials from inception to Clinical Study Report completion to drive meaningful change for patients and healthcare providers. Author and implement operational plans for efficient study enrollment and monitoring activities. Participate in audits and regulatory inspections as needed.
This position is posted by Jobgether on behalf of a partner company.
Creates and delivers education to the Coding Team, Clinical Documentation Nurses, Physicians, and other licensed providers to improve the quality of documentation.
Collaborates with the CMOs to ensure the integrity of the Health Record is established through best practices in Clinical Documentation and Coding.
Analyzes dashboard and audit data to derive conclusions and construct action plans.
At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace.