Prospective chart reviewer Job at Randstad (Banavathi)

Physician Coding Review Specialist

Location

United States

Salary:

26.55 - 39.85 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA)
Coding Specialist - Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA)
Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA)
Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA)
Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC)
Specialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC)
Specialty Medical Coding Certification issued by the American Academy of Professional Coders (AAPC)
Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist
Typically requires 5 years of experience in expert-level professional coding and at least 3 years of experience in the education of clinicians in physician revenue cycle processes, health information workflows, and medical record auditing experience
Advanced knowledge of ICD, CPT, and HCPCS coding guidelines

Job Responsibility

Review assigned codes, which most accurately describe each documented diagnosis and/ or procedure according to established CPT, HCPCS, and ICD-10-CM coding guidelines along with modifier usage and medical terminology
Monitor all coding accuracy at various levels of detail and maintain coding quality as needed
Track coding issues and review coding inaccuracies to highlight areas of improvement
Report or resolve escalated issues as necessary
Responsible for reviewing Clinician documentation and billed codes for Medical Group physicians and non-physician clinicians
Review of medical records in collaboration with key stakeholders such as Internal Audit, Compliance, and Clinic Operations
Responsible for completing all certified coder quality reviews
Working in collaboration with Coding Production Leads and Supervisors
Follows the prospective and/or retrospective review plan to sample employed Clinician's medical record documentation in comparison to services selected for billing, based on best practice methodologies which will be presented and reviewed with Clinicians to provide feedback on proper coding and documentation practices
Follows the necessary schedules for team assignments of documentation/coding accuracy

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Pharmacist

This full-time (0.9 FTE) inpatient clinical pharmacist position is based at the ...

Location

United States , Albuquerque

Salary:

63.47 - 82.51 USD / Hour

UNM Hospitals

Expiration Date

Until further notice

Requirements

Program Graduate
Accredited College of Pharmacy
CPR for Healthcare/BLS Prov or Prof Rescuers w/in 30 days
Pharmacist License in NM w/in 90 days
Pharmacy experience in a community or hospital pharmacy as a licensed pharmacist or intern as determined by review committee

Job Responsibility

Consult with and educate physicians, other health professionals, and patients and their families about drug usage, drug dosage, and drug substitution
Focus on the cost effective and safe usage of drugs in inpatient, outpatient, and ambulatory settings and on improving the quality of care given to patients
Compound and dispense medications and pharmaceutical supplies on written order from a physician
Participate in Continuous Improvement (CQI program at the UNM Hospitals)
Ensure adherence to UNM Hospitals and departmental policies, procedures and guidelines
Patient care assignments may include neonate, pediatric, adolescent, adult and geriatric age groups
PROFESSIONALISM - Maintain professional environment in communications, duties, tasks, interactions and customer service
PRESCRIPTIONS/ORDERS - Weigh, measure and mix ingredients
compound and prepare medication emulsions, liquids, powders, and ointments using graduates, balance, mortars, pestles and funnels
PRESCRIPTIONS/ORDERS - Fill prescriptions or orders from bulk stock

What we offer

Relocation Assistance Available
Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials

Fulltime

RN Lead Workflow Specialist

Join Our Team! Tennessee Quality Care is Hiring a Lead Workflow Specialist. Work...

Location

United States , Lebanon, TN

Salary:

Not provided

Arcadia Home Care and Staffing - an Addus family company

Expiration Date

Until further notice

Requirements

Degree in Nursing, PT, OT, SLP or other health related field
Possession of a current license to practice in the residing state
One (1) to two (2) years of clinical home health experience required
Working knowledge of OASIS and ICD-10 coding
Possess and maintains current CPR certification
Detail oriented and able to work with minimal supervision
Strong communication skills and interpersonal skills
Valid driver’s license and proof of insurance is required
MUST HAVE A MULITSTATE [sic] license
Must have Home Health, and OASIS expereince [sic]

Job Responsibility

Prospectively reviews all OASIS assessments to ensure appropriateness, completeness, and compliance with federal and state regulations and organization policy
Ensures appropriate ICD-10 coding and sequencing as it relates to the patient’s medical condition, including any co-morbidities
Works with managers to address trends that affect the agency’s outcome and process measures noted during OASIS review
Makes OASIS inter-rater reliability visits with clinical staff
Participates in Quality Improvement and Corporate Compliance activities as assigned
Assists with other chart audit activities as assigned

What we offer

Great culture and team atmosphere
Comprehensive benefits, including medical, dental, and vision, effective on the first of the month
401(k) retirement plan with a generous company match
Generous time off accruals
Paid holidays
Tuition Reimbursement
Employee Referral Program
Merit Increases
Employee Discount Programs

Fulltime

RN Supervisor

RN Supervisor for the Emergency Department at Atrium Health University City, wor...

Location

United States , Charlotte

Salary:

44.15 - 66.25 USD / Hour

Advocate Aurora Health

Expiration Date

Until further notice

Requirements

Valid, active unencumbered Nursing license approved by the Georgia Licensing Board for GA locations and Alabama Licensing Board for AL locations
BLS certification
Graduate of an accredited school of Professional Nursing
Progressive leadership
Administrative and clinical competencies
Full range of body motion including handling and lifting patients, manual and finger dexterity and eye-hand coordination
Standing and walking for extensive periods of time
Occasionally lifts and carries weight up to 50 pounds
Ability to distinguish letters, numbers and symbols with vision and hearing within normal range to respond to Code alerts and equipment alarms
Work-related stress due to volume and time constraints with irregular working hours

Job Responsibility

Handles daily staff and physician professional and clinical issues
Implements standards that ensure safe effective patient care
Reports and documents accurately through ICIS (electronic medical record) or by hard copy when necessary
Observes equipment and supply utilization and techniques used in preparation, cleaning and storing equipment and takes actions to improve methods
Provides input to the director relative to unit staffing variances
Evaluates staff performance and makes recommendations
Assists the Director with Performance Evaluations
Interviews prospective employees along with Director
Conducts staff disciplinary action according to policy and procedure
Supervises patient care staff including orienting, training, counseling and evaluating

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Coder IV facility hospital based

Location

United States

Salary:

30.15 - 45.25 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Minimum of five years' of coding experience in an academic medical center or an equivalent combination of coding experience and education with demonstrated competency of knowledge base
Coding QA background or similar experience preferred
Satisfactory completion of college level courses in anatomy, physiology and medical terminology preferred
EPIC health information system experience preferred
Coding certification CCA, CIC, CPC-H, CPC, CCS, RHIT, or RHIA required
Ability to concentrate for extended periods
Knowledge of medical terminology and basic anatomy, physiology, pathophysiology, and pharmacology with ability to apply knowledge to the coding process
Demonstrates skill in coding classification systems, diagnosis, procedure selection, and sequencing guidelines
Knowledge of APC prospective payment system
Demonstrates competence in coding and correct extrapolation of official coding and select billing guidelines to specific coding situations

Job Responsibility

Ensures the timely and accurate coding and completion of patient accounts within established departmental accuracy and productivity standards
Applies correct ICD CM/PCS (Inpatient) and ICD CM/CPT codes (Outpatient) guidelines meeting departmental policy regarding compliant methods, timeframes, use of applications and productivity
Assists in demonstrating medical necessity for procedures performed by ensuring that all documented disease processes are coded
Demonstrates proficiency in utilizing official coding books as well as the electronic medical record, computer assisted coding/encoding software, and clinical documentation information systems to facilitate code assignment
Reviews facility charges as provided and edits where necessary to ensure charges are compliant and substantiated by provider documentation
May require frequent and close collaboration with multiple areas of the organization including providers, Professional Coding, and Finance for audit and problem-solving activities
Demonstrates full understanding and is compliant with correct coding initiative guidelines, regulatory requirements regarding coding of medical information including but not limited to external regulatory agencies such as Quality Improvement Organizations (QIOs), the Centers for Medicare & Medicaid Services (CMS) and other payers, and the Joint Commission
Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines
Queries physician when existing documentation is unclear or ambiguous following AHIMA guidelines and established policy
Brings identified concerns to Manager Coding for resolution

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Utilization Management Admissions Liaison RN II

The Utilization Management (UM) Admissions Liaison RN II is primarily responsibl...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
Minimum of 7 years of clinical experience in an acute hospital setting
Previous experience to have a strong understanding of Utilization Management/Case Management practices including, but not limited to, placement (with level of care) criteria (MCG, InterQual), concurrent review, and discharge planning
Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint
Provision of excellent customer service required due to frequent communication with providers and other members of the interdisciplinary team
Knowledge of personal computer, keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment
Excellent time management and priority-setting skills
Maintains strict member confidentiality and complies with all HIPAA requirements
Strong verbal and written communication skills
Registered Nurse (RN) - Active, current and unrestricted California License

Job Responsibility

Provides the primary clinical point of contact for inpatient acute care hospitals requesting Inpatient care/post-stabilization admission requests, Higher level of care transfers and other emergent transfers or needs
Establishes and maintains ongoing communication with internal stakeholders and external customers while securing the L.A. Care member's admission or inter-facility transfer
Applies clinical expertise and the nursing process to triage and prioritize admission acuity, servicing as an expert clinical resource for patient placement while utilizing medical knowledge and experience to facilitate consensus-building and development of satisfactory outcomes
Continually seeks new ways to improve processes and increase efficiencies
Completes all inpatient and discharge planning requests appropriately and timely including, but not limited to: Skilled nursing facility, outpatient needs (home health, physical therapy, infusion), and case management referrals
Performs prospective, concurrent, post-service, and retrospective claim medical review processes
Performs other duties as assigned

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Physical Therapist - Case Manager Home Health

Physical Therapist - Case Manager Home Health - Franklin and Surrounding Areas

Location

United States , Franklin

Salary:

44.15 - 66.25 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Physical Therapy License in the State of Illinois or State of Wisconsin, must be licensed in the State upon which you work
Basic Life Support (BLS) for Healthcare Providers (obtained within 90 days unless department leader has determined is not required) by American Heart Association (AHA)
A valid drivers license issued by the Division of Motor Vehicles
Doctorate degree in Physical Therapy from an accredited school or educational requirements commensurate with the date of graduation
Maintains continuing education requirements as mandated by applicable state professional standards
Requires 1 year of clinical experience or demonstration of strong spectrum of clinical affiliation experience
Demonstrated knowledge of indications and contraindications of modalities and exercise
Demonstrated skill in use of modalities, exercise equipment, and other devices that are available in work area
Demonstrated proficiency in clinical skills with the ability to work independently and make sound judgments
Good human relations, organization, problem solving, and decision-making skills

Job Responsibility

Conducts a physical therapy evaluation of each patient and establishes a plan of care and treatment goals
Interprets physician referrals and completes musculoskeletal, neuromuscular, cardiopulmonary, and/or integument evaluations utilizing appropriate methods
Evaluates outcomes within an appropriate time frame
Provides on-going assessment of patient response to treatments and teaches and applies interventions as appropriate
Updates and revises plan of care as indicated and provides physician with status report on a regular basis
Communicates problems to physicians and management and clearly states plans, actions and goals so changes are reflected as they occur
Completes a plan of care as indicated and provides physician with status report
Maintains and updates clinical and patient records according to state and federal guidelines
Manages assigned caseload including scheduling and informing site leadership of coverage needs and ability to provide coverage
Manages patient's medical condition including medications

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Physical Therapist - Case Manager Home Health

Location

United States , Franklin

Salary:

44.15 - 66.25 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Physical Therapy License in the State of Illinois or State of Wisconsin, must be licensed in the State upon which you work
Basic Life Support (BLS) for Healthcare Providers (obtained within 90 days unless department leader has determined is not required) by American Heart Association (AHA)
A valid drivers license issued by the Division of Motor Vehicles
Doctorate degree in Physical Therapy from an accredited school or educational requirements commensurate with the date of graduation
Maintains continuing education requirements as mandated by applicable state professional standards
Requires 1 year of clinical experience or demonstration of strong spectrum of clinical affiliation experience
Demonstrated knowledge of indications and contraindications of modalities and exercise
Demonstrated skill in use of modalities, exercise equipment, and other devices that are available in work area
Demonstrated proficiency in clinical skills with the ability to work independently and make sound judgments
Good human relations, organization, problem solving, and decision-making skills

Job Responsibility

Conducts a physical therapy evaluation of each patient and establishes a plan of care and treatment goals
Interprets physician referrals and completes musculoskeletal, neuromuscular, cardiopulmonary, and/or integument evaluations utilizing appropriate methods
Evaluates outcomes within an appropriate time frame
Provides on-going assessment of patient response to treatments and teaches and applies interventions as appropriate
Updates and revises plan of care as indicated and provides physician with status report on a regular basis
Communicates problems to physicians and management and clearly states plans, actions and goals so changes are reflected as they occur
Completes a plan of care as indicated and provides physician with status report
Maintains and updates clinical and patient records according to state and federal guidelines
Manages assigned caseload including scheduling and informing site leadership of coverage needs and ability to provide coverage
Manages patient's medical condition including medications

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Prospective chart reviewer

Randstad

Location:
India , Banavathi

Category:
Health and Beauty

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
March 04, 2026

Expiration:
April 16, 2026

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Job Description:

Job Responsibility:

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