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Job Description: Medical Auditor - HEDIS Medical Auditor - HEDIS Location: Iselin, NJ Salary: $18-$20 per hour Experience: 5.0 year(s) Job Type: Temporary / Consulting Job ID: U1009520       About the Opportunity A premier healthcare network is actively seeking a Medical Auditor, with strong HEDIS knowledge, for a promising opportunity on their staff. In this role, the Medical Auditor will work with the HEDIS team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific data base.  If necessary, the medical record review is conducted on-site in provider office or hospital institution. This candidate will be required to handle a high volume of telephonic interaction with provider offices. Candidates must follow up on requested medical records with providers, and must keep excellent documentation of research and contact information. Apply today! Company Description Healthcare Network Job Description The HEDIS Medical Auditor will: Work under the supervision of internal staff and designated lead in order to achieve goals and keep the project moving Reviews require data analysis and research within data systems  Audit CMS and / or Commercial Insurance billing for diagnosis data collected from physician and hospital medical records Review and research medical records to determine the accuracy of coding, billing and supporting clinical documentation Assist pursuit staff as needed in requesting records Assist the team with research and documentation Maintain current knowledge of requirements and guidance required in the performance of audit duties Review medical records that have been reviewed and coded by the coding vendor Required Skills CPMA (Medical Auditing Certification) from accredited source  or equivalent certification requirement 5+ years of experience relevant ICD-9 coding or medical record audit experience in a consultative role 2-year Associate Degree through a technical school or community college Prior experience with research and either HEDIS measures or auditing data submitted as claims Proven computer skills and analysis capabilities in order to navigate CPT4 code and ICD9 DX based on HEDIS Technical Specification requirements Understanding of codes for services based on diagnosis and procedure Research and detail-oriented with the tenacity to find claim specific data for a specific measure within a given period of time Basic Excel skills and must have the ability to type 30-40 WPM Desired Skills Prior HEDIS experience

Job Description: Cost Outlier Auditor (RN) Cost Outlier Auditor (RN) Location: New York, NY Salary: $80,000-$85,000 Experience: 2.0 year(s) Job Type: Full-Time Job ID: J133091       About the Opportunity The Review Operations Department of a recognized healthcare company is currently seeking a licensed Registered Nurse (RN) for a promising Cost Outlier Auditor position with their growing staff. Reporting to the Vice President of Review Operations, the Cost Outlier Auditor (RN) will be responsible for handling cost outliers and special projects and insuring their completion. Apply today! Company Description Healthcare Company Job Description The Cost Outlier Auditor (RN) will: Complete all aspects of cost outlier work independently Maintain and update training materials as needed Maintain and update all hospital profiles as needed Assist with the training and orientation of all new staff Communicate with External Liaisons on issues specific to projects and with account representatives specific to program process Perform Quality Assurance of reviewers as assigned Perform various reviews such as Cost Outliers, Day Outliers, Pre and Post payment Utilization review, Quality Reviews and review of outpatient claims Assist the Operations department with data abstraction for special studies Required Skills 2+ years of Utilization Review and Managed Care experience; 2+ years of experience in a Hospital setting BSN NYS Registered Nurse (RN) Experience reviewing charts Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively

Job Description: Assistant Director of Bill Review and Audit (RN) Assistant Director of Bill Review and Audit (RN) Location: Bedminster, NJ Salary: $95,000-$105,000 Experience: 5.0 year(s) Job Type: Full-Time Job ID: J135403       About the Opportunity A healthcare organization in New Jersey is currently seeking a licensed Registered Nurse (RN) to join their Management Team as their new Assistant Director of Bill Review and Audit. In this role, the Assistant Director of Bill Review and Audit (RN) will be responsible for evaluating the current non-accept process and processing all "non-accepts" on a daily basis that have been submitted by Nurse Auditor staff. Apply today! Company Description Healthcare Organization Job Description The Assistant Director of Bill Review and Audit will be responsible for: High dollar claim distribution Overseeing Peer Review activity Serving as a clinical resource for bill review appeals Serving as a liaison for the Pharmacist Consultant & Medical Recovery Services Identifying new vendor relationships and revenue opportunities Establishing goals and objectives and recommending new methods to improve departmental procedures Identifying new tools and software's via third party vendors to be used to enhance the audit process Identifying seminars, boot camps, and training opportunities to continue education of Nurse Audit staff Conducting weekly/bi-weekly departmental meetings and case studies Assisting in recruiting Nurse Auditors with the assistance of the Human Resource Department Required Skills 7+ years of Auditing, Claims, Review, and/or Billing experience with a Healthcare Organization; 4+ years of previous Management experience Bachelor's Degree in a related field NJ Registered Nurse (RN) license Experience and working knowledge of Healthcare, Medicare guidelines and various Healthcare programs Exceptional clinical skills to evaluate appropriate Medical Record Coding Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized

Job Description: Coding Specialist Associate Coding Specialist Associate Location: Tarrytown, NY Salary: $20-$21 per hour Experience: 1.0 year(s) Job Type: Temporary / Consulting Job ID: U1011084       About the Opportunity An established healthcare facility located in Tarrytown, NY is actively seeking a dedicated and analytical professional for a promising opportunity on their staff as a Coding Specialist Associate. In this role, the Coding Specialist Associate will work closely with independent auditors and external exam teams to provide necessary support and materials necessary to test compliance programs and activities. Company Description Healthcare Facility Job Description The Coding Specialist Associate will: Assist in the oversight of compliance program and activities Assist with establishing compliance policies Monitor, and as necessary, coordinate compliance activities, to remain abreast of the status of all compliance activities and to identify trends Audit documentation to ensure it supports complete, accurate and compliant billing with both CMS and payer requirements Provide reports on all findings upon completion audits Assist in the development of site and provider specific training, as well as corrective action plans based on audit results Track and trend audit results Review monthly list of refunds provided by Compliance Team to verify that a refund has been appropriately processed Work closely with the Regulatory Associates to manage outside auditors Required Skills CPC-A certifications Experience with and exposure to compliance matters Specific knowledge of the regulations and guidelines as they relate to documentation and coding Superior verbal, written, organizational and interpersonal skills Competency with Microsoft Office (Excel, Word and PowerPoint) Solid ability to organize and prioritize workload to manage multiple tasks and meet deadlines Desired Skills Experience with revenue management or background from the healthcare industry 2+ years of coding experience CPC, CCS, CCS-P, CPMA, CEMC or CENTC certification Compliance certifications (CHC, CPCO) and/or Bachelor's Degree

Job Description: Credentialing Coordinator Credentialing Coordinator Location: Boston, MA Salary:  Experience: 3.0 year(s) Job Type: Temporary / Consulting Job ID: U1015894       About the Opportunity A premier healthcare facility located in Boston is actively seeking a self-motivated and analytical professional for a promising opportunity on their staff as a Credentialing Coordinator. Under the direction of the Director of the CVO, the Credentialing Coordinator assists the CVO staff with data entry and obtaining primary source verifications. Apply today! Company Description Healthcare Facility Job Description The Credentialing Coordinator: Ensures all credentialing system data and documentation comply with internal and external auditors of compliance and all applicable accreditation standards Requests primary source verification from appropriate sources and follows-up on a timely basis to ensure processing turnaround times are achieved Analyzes errors and traces back to the root cause using the raw data in the appropriate file or database as it relates to initial appointment and reappointment files, as well as expirables Analyzes provider records for completeness, accuracy, and consistency Communicates and works with appropriate Medical Staff Office to resolve data discrepancies Enters data accurately and completely in the credentialing software Required Skills Bachelor's Degree in Healthcare Administration 3+ years of credentialing experience in a hospital medical staff services department Comprehensive knowledge and experience with credentialing standards according TJC and CMS standards Strong database skills Detail-oriented Excellent customer service skills Ability to multitask

Job Description: Coding Specialist Coding Specialist Location: Tarrytown, NY Salary: $30-$32 per hour Experience: 0.0 year(s) Job Type: Temporary / Consulting Job ID: U1005381       About the Opportunity A recognized healthcare facility located in Tarrytown, NY is actively seeking a self-motivated and dynamic healthcare professional for a promising opportunity on their staff as a Coding Specialist. Under the direct supervision of the Director of Regulatory Affairs, the Coding Specialist will assist in the evaluation of clients  medical records and claims submissions to ensure completeness, accuracy, and compliance with applicable federal and state regulations and guidelines. For the right candidate, this role has the potential to transition into a full-time opportunity. Company Description Healthcare Facility Job Description The Coding Specialist will: Assist in the oversight of compliance program and activities Work closely with independent auditors and external exam teams to provide necessary support and materials Assist with establishing compliance policies Monitor, and as necessary, coordinate compliance activities, to remain abreast of the status of all compliance activities and to identify trends Audit documentation to ensure it supports complete, accurate and compliant billing with both CMS and payer requirements Provide reports on all findings upon completion audits Assist in the development of site and provider specific training, as well as corrective action plans based on audit results Track and trend audit results Required Skills CPC 2 years of coding experience Experience with and exposure to compliance matters Specific knowledge of the regulations and guidelines as they relate to documentation and coding Superior verbal, written, organizational and interpersonal skills Competency with Microsoft Office (Excel, Word and PowerPoint) Solid ability to organize and prioritize workload to manage multiple tasks and meet deadlines Desired Skills CHC, CPCO and/or Bachelor's Degree Revenue management or background from the healthcare industry: hospitals, physician practices, medical billing companies, healthcare management companies

Job Description: UAS Nurse (RN) UAS Nurse (RN) Location: New York, NY Salary:  Experience: 0.0 year(s) Job Type: Temporary / Consulting Job ID: U1004160       About the Opportunity A promising opportunity as a UAS Nurse currently awaits a self-motivated and diligent Registered Nurse (RN) at a recognized healthcare organization located in New York City. In this role, the UAS Nurse will be responsible for the completion of organization members' UAS Assessment, ATSP, and all associated plan documentation. Company Description Healthcare Organization Job Description The UAS Nurse (RN): Conducts UAS Assessment at Member's place of residence Completes the UAS, Aide Task Service Plan, and all other documents required by Health Plan Completes and conducts validation audits of UAS and ATSP Uploads UAS to DOH website Communicates daily with UAS Coordinator regarding any issues with assessments Send updates to office staff using the iForm Application on the iPhone Coordinates with UAS-ATSP Auditors for all remedial education and Audit corrections and updates Provides member education regarding health issues, medication and plan benefits Required Skills Active New York State Registered Nurse license Strong attention to detail 1 year of Hospital and Home Care experience as an RN Polished and professional demeanor Ability to multitask Excellent communication skills Patient-oriented Highly organized Compassionate and empathetic Desired Skills BSN UAS-certified Knowledge of care management

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