Interviewer jobs at Emory Healthcare

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under general supervision, the Special Investigations Unit Medical Reviewer (SIU Medical Reviewer) performs reviews of medical records and healthcare claims to substantiate or refute the accuracy and compliance with federal and state regulations and contractual requirements of codes billed to identify coding errors and billing discrepancies in relation to incidents of suspected healthcare fraud, waste, and abuse (FWA) reported to IEHP's Compliance Special Investigations Unit (SIU). Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary Hybrid schedule State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account - Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities Perform reviews of medical records and healthcare claims, determining the accuracy of codes billed and compliance with appropriate policies, procedures, and regulations. Understand, interpret, analyze, and make determinations concerning use of CDT, CPT, ICD, DRG, REV and HCPCS coding as it relates to potential healthcare FWA schemes. Conduct research relevant to issues under review. Prepare and submit detailed reports with the results of medical reviews, including corrective action recommendations to investigators. Recommendations may include determinations to deny, recover on overpaid claims, risk mitigation strategies, create internal process improvements or provide education to subjects under review. Apply knowledge of healthcare coding conventions, policies, and other areas of vulnerability. Support/participate in provider calls and reinforce medical review findings and provider education. Presents findings to leadership, regulators and law enforcement and assist in legal proceedings, as appropriate. Maintain knowledge of new and relevant regulations, standards, and coding guidelines. Identify inefficiencies in policies or processes and recommend improvements. Maintain confidentiality and discretion in all investigative activities. Support special projects and other duties as assigned. Qualifications Education & Requirements A minimum of two (2) years of experience performing medical reviews of medical records and claims in a healthcare setting Bachelor's degree in Medical Billing/Medical Coding, Nursing, Healthcare Administration, or related field from an accredited institution required In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position This experience is in addition to the minimum years listed in the Experience Requirements above Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or Certified Coding Specialist (CCS) required One of the following licenses preferred: Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN Key Qualifications Must have a valid California Driver's license Strong understanding of medical coding, billing practices, and healthcare regulations Thorough understanding of ICD, CPT, HCPCS, DRG, revenue codes, NDC's and other guidelines and general understanding of investigative processes within a healthcare environment are required Knowledge of Medi-Cal and Medicare rules and regulations, and managed care in California is preferred Strong verbal and written communication, interpersonal skills, critical problem-solving skills, and attention to detail Above average proficiency in the use of technology applications, particularly Excel, Word, and others as necessary Detail-oriented with strong organizational and time management abilities. Ability to articulate medical review findings clearly and thoroughly Conduct research in support of medical reviews and make determinations on claims with a high level of accuracy Demonstrated ability to interpret and analyze healthcare data and records Adapt to different technology software and platforms, including anti-fraud solutions Ability to work independently and collaboratively with a team Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.) Pay Range USD $71,572.80 - USD $93,038.40 /Yr.

Cardiac RN Opportunities: CSICU, Cardiac Surgery Stepdown, CICU - The Mount Sinai Health System Qualifications for our Cardiac RN positions (Cardiac Surgery Stepdown, CCU, CSICU) 1 to 2+ years of experience in Cardiac and/or Telemetry or Medical Surgical Experience in critical care is preferred BSN Nursing required ACLS/BCLS required NYS RN Licensure Qualifications for our Procedural RN positions (Interventional Radiology, Cath Lab): 2 to 3+ years of experience in Critical Care required BSN Nursing required ACLS/BCLS required NYS RN Licensure Roles & Responsibilities: The Clinical Nurse is a Registered Professional Nurse who provides safe, competent quality care based on nursing theory and research to a designated group of patients and significant others.

At Zelis, we Get Stuff Done. So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients. A Little About You You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines and rules, evidence based clinical criteria plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest savings for clients. What you'll do: Perform comprehensive inpatient DRG validation reviews to determine accuracy of the DRG billed, based on industry standard coding guidelines and the clinical evidence supplied by the provider in the form of medical records such as physician notes, lab tests, images (x-rays etc.), and with due consideration to any applicable medical policies, medical best practice, etc. Based on the evidence presented in the medical records, determine, and record the appropriate (revised) Diagnosis Codes, Procedure Codes and Discharge Status Code applicable to the claim. Using the revised codes, regroup the claim using provided software to determine the ‘new DRG'. Determine where the regrouped ‘new DRG' differs from what was originally claimed by the provider, write a customer facing ‘rationale' or ‘findings' statement, highlighting the problems found and justifying the revised choices of new codes and DRG, based on the clinical evidence obtained during the review Document all aspect of audits including uploading all provider communications, clinical rationale, and/or financial research Identify new DRG coding concepts to expand the DRG product. Manage assigned claims and claim report, adhering to client turnaround time, and department Standard Operating Procedures Meet and/or exceed all internal and department productivity and quality standards Recommend new methods to improve departmental procedures Achieve and maintain personal production and savings quota Maintain awareness of and ensure adherence to Zelis standards regarding privacy What you'll bring to Zelis: Registered Nurse licensure preferred Inpatient Coding Certification required (i.e., CCS, CIC, RHIA, RHIT) 3 - 5 years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims preferred Solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs Understanding of hospital coding and billing rules Clinical skills to evaluate appropriate Medical Record Coding Experience conducting root cause analysis and identifying solutions Strong organization skills with attention to detail Outstanding verbal and written communication skills Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future. Location and Workplace Flexibility We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies. Base Salary Range $79,000.00 - $105,000.00 At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role. Zelis' full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees' health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage. Equal Employment Opportunity Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all. Accessibility Support We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email ***************************. Disclaimer The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.

Job Category: Revenue Cycle Work Shift/Schedule: 8 Hr Morning - Afternoon Northeast Georgia Health System is rooted in a foundation of improving the health of our communities. The Coding Quality Reviewer II is responsible for performing quality analysis of coded medical records, documenting the analysis, summarizing the metrics and reporting quality statistics to management. Responsible for complex multi-specialty coding to include but not limited to: Neurosurgery, UI, Neurology, Critical Care, hospitalists, surgical and others as defined. The Coding Quality Reviewer II is also responsible for communicating identified issues to coding staff and management, as well as reviewing and correcting coding issues from the EMR and PMS systems. In addition, the Coding Quality Reviewer II may be called upon to provide education to staff and clients, prepare coding audits for physician education, and/or coding charts as business needs dictate. The Coding Quality Reviewer II is responsible for providing and ensuring accurate, complete and timely coding of professional services to include all surgical and inpatient services. All coding staff must ensure accuracy and compliance with regulatory standards. Coding Quality Reviewer II is also responsible for performing audits in accordance with NGPG's annual Compliance Work Plan and preparing written and oral communications to the Coding Compliance Manager. Minimum Job Qualifications Licensure or other certifications: CPC and/or CCS-P Coding Certification required Educational Requirements: High School Diploma or GED Minimum Experience: Three (3) years experience coding Multi-Specialty records required. Other: Preferred Job Qualifications Preferred Licensure or other certifications: Preferred Educational Requirements: Preferred Experience: Other: Job Specific and Unique Knowledge, Skills and Abilities Extensive knowledge of ICD-9, CPT, HCPCS coding, medical terminology, federal and state regulatory guidelines and third party payor requirements required Accuracy and attention to detail imperative Ability to interact well with others at all levels with a flexible, energetic, proactive and positive style In-depth knowledge of Optimal coding policy and procedures Highly skilled proficient with Microsoft Office products Ability to communicate (both verbally and written) technical coding information to both technical and non-technical audiences Ability to organize data and provide detailed reporting Ability to prepare presentations and present to large or small audiences Must be highly motivated, detail oriented individual Excellent written and oral communication skills Problem solving and analytical skills Ability to be a self starter/work independently and as a team player Ability to travel to NGHS/NGPG sites as needed Essential Tasks and Responsibilities Perform timely, concurrent quality review of coded medical records. Correct errors identified in the quality process in both EMR and PMS systems. Maintain coding quality statistics and provide detailed reporting to management. Communicate errors to the Posting, Clinicians and AR staff on an individual basis. Communicate to management any problem areas identified in the quality process and steps taken to resolve. Assist with the review and correction of coding errors in the billing process (TM queues). Assist with the review and correction of coding errors in the electronic claims process (clearinghouse on-line errors). Promptly and professionally respond to both verbal and written coding questions from the internal staff and other areas of the company. Review documentation deficiencies for accuracy and communicate identified errors to the coding staff and management. Prepare documentation audits as needed for on-site physician education. Production coding of medical records as per business needs. Adherence to Coding policy and procedures. Review charge slips/cards for completeness (providers are ultimately responsible for codes they assign). Attends Regional and Local sponsored in-services and/or continuing education. Participates in professional development activities and maintains professional affiliations as necessary. Provide and/or validate CPT, ICD-9-CM and HCPCS coding of professional services for outpatient clinics, outreach offices or programs, minor diagnostic procedures, and/or ancillary services. Review charge tickets for missing or inaccurate information. Items reviewed include service and diagnosis codes units of service, modifiers, facility code, place of service, provider billing numbers, etc. Communicate with providers and clinic staff to ensure charge capture of all professional services, supplies, drugs, vaccinations, etc. Monitor reconciliation procedures to ensure all charges are captured and billed in a timely manner. Research and correct claims manager edits in a timely manner by applying coding and carrier specific guidelines while maintaining compliance initiatives. Provide coding coverage to other specialties, departments, divisions, and/or units as required. Attend billing educational sessions to enhance coding knowledge i.e. American Academy of Professional Coders, Professional Medical Coding Curriculum, NGPG Compliance Proficiency training, specialty seminars. Performs other job duties as assigned. Cross trains in other positions as requested. Physical Demands Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time Weight Carried: Up to 20 lbs, Occasionally 0-30% of time Vision: Moderate, Frequently 31-65% of time Kneeling/Stooping/Bending: Occasionally 0-30% Standing/Walking: Occasionally 0-30% Pushing/Pulling: Occasionally 0-30% Intensity of Work: Frequently 31-65% Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding, Driving Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals. NGHS: Opportunities start here. Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.

Join Our Award-Winning Care Team! Ready to get started? Text CARE to ************ for an immediate interview and same-day call back! Right at Home, a top-rated in-home care agency, is looking for compassionate HHAs and PCAs to support clients across Nassau & Suffolk Counties. If youre caring, dependable, and love making a difference, wed love to meet you. Drivers license preferred but not required. What Youll Do: Provide supportive, hands-on care to seniors and individuals with disabilities. Tasks may include: Light housekeeping & meal prep Medication reminders Companionship & errands Assistance with bathing, dressing & grooming Most care is provided in the clients home. Travel and shift times vary based on client needs Requirements: English communication skills Pass background check & drug screening HHA/PCA certification (Drivers license a plus, not required) Full-time, part-time, and live-in roles available Ready to join a team that values you? Call ************ or text CARE for an immediate interview , or apply online at ******************* or our website. Required qualifications: Legally authorized to work in the United States 18 years or older Preferred qualifications: Medical license/certification: Home Health Aide Certification Medical license/certification: CNA License Valid driver's license Speaks English Reads English

Hispanic Federation (HF) is the nation's premier Latino nonprofit membership organization. Founded in 1990, HF supports Hispanic families and strengthens Latino institutions through grantmaking, capacity building, policy, advocacy, and direct services in the areas of education, health, immigration, civic engagement, economic empowerment and the environment. Values that drive our work include equality, fairness, diversity, and empathy. Project Overview Through the generous support of New York State's Office for New Americans (ONA), Hispanic Federation has managed programs and community outreach to communities impacted by the immigration system. Through direct services and regranting, Hispanic Federation and its nonprofit partners work closely to provide direct services to newly arrived New Yorkers in need of immigration guidance and support. Throughout the lifetime of the program, Hispanic Federations aims to connect with over 40 New York community-based organizations (CBOs) and positively impact over 71,000 immigrant New Yorkers across the five (5) boroughs and Suffolk and Nassau County on Long Island, NY. As part of our programmatic work, HF seeks a qualified fiscal management organization to assist in the review, correction, and approval of financial reports for payments and compliance with reporting standards set by the New York State Office for New Americans. The fiscal management organization will work closely with both program and finance departments to ensure that all work meets outlined standards for reporting and vouchering purposes. The fiscal management organization must have the capacity to support detailed financial reviews, provide direct feedback to partner community-based organizations, and alert all HF departments of any findings which require intervention. To ensure partners comply with contractual obligations, the fiscal management organization will also provide technical assistance, including one-on-one meetings, site visits, and tailored training or support sessions as needed. Performance Period January 1, 2026 through August 14, 2026 Total Funds Available: Up to $100,000 Payments and Reporting Consultants will submit monthly invoices using a template provided by HF. All payments must be aligned with the progress toward deliverables. Scope Consultant will serve in the following capacities: Provide Feedback and Documentation: Participate in HF's fiscal and programmatic training to understand reporting standards. Prepare and deliver feedback for partner community-based organizations, ensuring clarity and citing policies, protocols, and procedures as necessary and as requested. Ensure timely follow-up with partner CBOs on the approval process, ensuring that feedback is received and incorporated promptly. Facilitate submission of final reports for assigned CBOs with HF program and finance departments. Document inconsistencies and errors to ensure development and growth, flag serious irregularities for both program and finance departments for remediation. Prepare one-page reports for all partner CBOs as submissions are completed, providing feedback on the process for future reference. Internal Report Review: Review reports as they are received and prepare feedback, noting missing documentation, inconsistencies, and providing remedies whenever possible. Complete detailed review of personnel and OTPS expenditures for accuracy, execute in-depth reviews of personnel documentation (timesheets, calculated fringe rates, proration, etc.) and programmatic/OTPS expenditures (invoices, receipts, reimbursements, etc.), and confirm expenses are allowable as per standards and contract deliverables. Confirm all signatures and required back-ups are present and valid. Ensure compliance with standards outlined by Hispanic Federation's Finance and Program Teams, provide feedback as needed to support streamlining HF's grant making processes. Prepare Packets for Submission: Consolidate all payment packages in a logical and easy-to-review manner, outlining any additional considerations. Ensure errors are addressed and any major issues are addressed prior to submission, relay all critical updates, as necessary to the program and finance departments. Requirements and Preferences Consultants must demonstrate: A minimum of 5 years of professional experience in public/non-profit program finance management and reporting. Experience working with multi-year, multi-million-dollar government grants and adhering to compliance and stated grant requirements. Experience handling a high volume of financial reporting from contracted nonprofit partners for the New York State Office for New Americans (ONA) is strongly preferred. Strong analytical skills, with expertise in grant management and contract review. Communicate financial recommendations and corrections effectively in a concise and easy-to-understand manner. Direct experience working with nonprofits serving communities of color. Cultural and community competence. Alignment with HF values. Excellent writing skills. Ability to adhere to project timelines and deliver high-quality work on schedule. Strong collaborative skills. Ability to meet all federal contractor requirements, including the Uniform Guidance for Federal Awards (2 CFR 200) and other federal, state, and local requirements as relevant. Consultants should preferably possess: MWBE New York State vendor certification. Education and certification in Financial Management, Accounting, and Business/Nonprofit Administration. Ability to design bilingual tools and guides in English and Spanish, and collect, aggregate, and analyze financial materials in both languages. Due Date and Submission No later than Friday, December 12, 2025. Applications are reviewed as they are received. Late applications will not be reviewed. Submit completed applications to *************************************. Proposal To apply, applicants must submit the following: A summary of services by the consulting firm and the resume of the potential consultant lead or resumes for each person who will be involved throughout the course of the project. MWBE Certification, if applicable. Budget and any rates for services provided. If chosen, consultants will also need to provide: W-9, signed and dated in 2026 (must be the updated W-9 form). Voided check or bank letter. A document of a staff training agenda or outline used in the past.

Full-time Description Employee is a Lead Bill Reviewer who will assist the Bill Review Supervisor in a variety of functions related to the ultimate goals of the department. Candidate's commute to the nearest office location is more than 50 miles Candidate must show exemplary productivity and performance Candidate must report to the closest office as needed for personnel meetings and training and/or as supervisor requests (at a minimum, once a month). Live in a location that can receive an approved high speed internet connection Have a “meets” or “exceeds” performance rating on most current performance review and currently meeting all performance expectations. Employee must not have an open Corrective Action Plan. Under close supervision, meets daily production quotas in processing and auditing medical bills in accordance with the appropriate workers' compensation fee schedule by performing the following duties. Essential Duties and Responsibilities: Must be able to process all clients' bills to serve as a team backup for all clients. Must be able to serve as a backup to the Bill Review Supervisor in day to day operations. Non-exempt employees must log all time worked in the Paylocity system including log-in and log-off time as well as lunch time. Codes medical bills into the company system with speed and accuracy, maintaining company production standards related to quantity and quality of output. Performs preliminary screening for appropriateness and medical necessity of services rendered. Uses CPT and ICD-10 codes, fee schedules, and other resource materials to determine appropriate reimbursement of billed services, including applicable fee schedule and/or repricing rational. Flags any problem bills. Communicates with clients and/or providers to clarify information Assists with bill review reporting functions (internal and external reports) May specialize in state specific or client specific areas of responsibility May assist is answering provider calls. May travel to other offices to assist with training May be called upon to assist with sales and marketing presentations Requirements Competency: To perform the job successfully, an individual should demonstrate the following competencies: Design - Demonstrates attention to detail. Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions. Team Work - Supports everyone's efforts to succeed. Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickl Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Excellent oral and written communication skills. Education and/or Experience: High school diploma or general education degree (GED), plus minimum of one year data entry/medical billing experience; additional two years bill review experience in a workers' comp environment. We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records. Salary Description $25.00 - $30.00

Founded in 1970, East Valley Community Health Center is a Federally Qualified Health Center (FQHC) who's services include providing personalized, affordable, high-quality medical, dental, vision and behavioral health care through a community-based network within the East San Gabriel Valley and Pomona Communities. Our staff practices patient-centered care by serving each patient with a personalized care plan that meets their individual needs. Our patients have access to support services that include, nutrition, health education, case management, pharmacy, lab, and x-ray at our health center locations. East Valley serves the health care needs of uninsured and underserved individuals and families throughout our 8 health center locations. Our mission is to provide access to excellent health care while engaging and empowering our patients, employees, and partners to improve their well-being and the health of our communities. The Quality Performance Reviewer is responsible for conducting daily review of medical charts to monitor and evaluate all relevant core processes and quality measures for compliance in accordance with federal, state, and health plans guidelines. This will include HEDIS and Medicare Advantage Star measure specifications. The Reviewer will ensure that workflow practices meet the professional standards of East Valley through the review of clinical documentation for completeness, accuracy, and compliance. The Reviewer will complete reviews within established timeframe and provide education to clinician and staff for documentation and quality improvement. The Reviewer may assist in developing corrective action plans as needed. The position may require travel within the different clinic sites. MAJOR POSITION RESPONSIBILITIES AND FUNCTIONS: Conduct daily reviews of medical records to ensure all required elements are documented appropriately Provide feedback to providers and care team members of incomplete or inaccurate documentation Continuously monitor areas of deficiency are addressed appropriately and timely by providers and care team members to meet internal requirements and regulatory standards Provide consistent and timely reporting of provider documentation issues to management Collects and enters confidential information ensuring the highest level of confidentiality in all areas Assist in the development of provider clinical education tools using chart findings to improve accuracy in documentation Assist in conducting mock audits in preparation for regulatory and health plan audits Maintain understanding and ability to interpret current regulatory agencies and health plans requirements related to medical record Ability to use independent judgement related to medical record review Other duties as assigned POSITION REQUIREMENTS AND QUALIFICATIONS: Minimum 2 years' experience with medical record review working in a health care setting Working knowledge of HEDIS and Medicare Advantage Star measures Experience with EMR systems, preferably NextGen Ability to be assertive and tactful when communicating with medical staff Knowledge of all current Windows based programs. Ability to multi-task and prioritize daily workload High Level of verbal and written communication East Valley offers a competitive salary, excellent benefits to include: medical, dental, vision, and 403b retirement plan. We match the first 6%of employee contributions, and full vesting starts immediately. You will also enjoy work-life balance with paid time off and paid holidays throughout the year. Please apply to this position with your current resume. Principals only. Recruiters, please do not contact this job posting. EOE is the Law. It is the stated policy of EVCHC to conform to all the laws, statutes, and regulations concerning equal employment opportunities and affirmative action. We strongly encourage women, minorities, individuals with disabilities and veterans to apply to all of our job openings. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, or national origin, age, disability status, Genetic Information & Testing, Family & Medical Leave, protected veteran status, or any other characteristic protected by law. We prohibit Retaliation against individuals who bring forth any complaint, orally or in writing, to the employer or the government, or against any individuals who assist or participate in the investigation of any complaint or otherwise oppose discrimination.

**Discover Your Career at Emory University** Emory University is a leading research university that fosters excellence and attracts world-class talent to innovate today and prepare leaders for the future. We welcome candidates who can contribute to the excellence of our academic community. **Description** KEY RESPONSIBILITIES: + Recruits, screens, identifies, contacts, and interviews participants to obtain data for assigned research projects. + Interviews may be conducted in person, in a clinical setting, the subject's residence, or by telephone. + Coordinates the data collection process. + May abstract data from the participant's medical record. + Schedules appointments, obtains consent forms, explains the study to the participant and collects data. + May observe participants and record results of observation through written documentation or video recording. + Edits completed questionnaires for completeness, legibility and accuracy. + Follows up with participants to obtain missing data or clarify existing data. + Designs forms, worksheets and study questionnaires. + May code and enter data into a database. + Compiles data and produces reports to be used for analysis of research findings. + May monitor blood pressure and heart rate and may take vital signs and height/weight measurements. + May collect blood, saliva, or urine samples from participants and prepare them for laboratory testing. + Provides direction to others engaged in the interviewing process. + Maintains required record-keeping. + Performs related responsibilities as required. MINIMUM QUALIFICATIONS: + A high school diploma or equivalent. + Two years of administrative support, customer service or other related experience which includes one year of interviewing experience. + Data entry experience. + Positions that require drawing blood require completion of a phlebotomy training program. NOTE: Position tasks are required to be performed in-person at an Emory University location; working remote is not an option. Emory reserves the right to change this status with notice to employee **Additional Details** Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law. Emory University does not discriminate in admissions, educational programs, or employment, including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training. Students, faculty, and staff are assured of participation in university programs and in the use of facilities without such discrimination. Emory University complies with Section 503 of the Rehabilitation Act of 1973, the Vietnam Era Veteran's Readjustment Assistance Act, and applicable executive orders, federal and state regulations regarding nondiscrimination, equal opportunity, and affirmative action (for protected veterans and individuals with disabilities). Inquiries regarding this policy should be directed to the Emory University Department of Equity and Civil Rights Compliance, 201 Dowman Drive, Administration Building, Atlanta, GA 30322. Telephone: ************ (V) | ************ (TDD). Emory University is committed to ensuring equal access and providing reasonable accommodations to qualified individuals with disabilities upon request. To request this document in an alternate format or to seek a reasonable accommodation, please contact the Department of Accessibility Services at accessibility@emory.edu or call ************ (Voice) | ************ (TDD). We kindly ask that requests be made at least seven business days in advance to allow adequate time for coordination. **Connect With Us!** Connect with us for general consideration! **Job Number** _156987_ **Job Type** _Temporary Full-Time_ **Division** _School Of Medicine_ **Department** _SOM: Medicine: Cardiology_ **Job Category** _Clinical Research_ **Campus Location (For Posting) : Location** _US-GA-Atlanta_ **_Location : Name_** _HSRB II (Health Sciences Research Building II)_ **Remote Work Classification** _No Remote_ **Health and Safety Information** _Position involves clinical patient contact, Working with human blood, body fluids, tissues, or other potentially infectious materials_

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! Under general supervision, the Special Investigations Unit Medical Reviewer (SIU Medical Reviewer) performs reviews of medical records and healthcare claims to substantiate or refute the accuracy and compliance with federal and state regulations and contractual requirements of codes billed to identify coding errors and billing discrepancies in relation to incidents of suspected healthcare fraud, waste, and abuse (FWA) reported to IEHP's Compliance Special Investigations Unit (SIU). Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. * Competitive salary * Hybrid schedule * State of the art fitness center on-site * Medical Insurance with Dental and Vision * Life, short-term, and long-term disability options * Career advancement opportunities and professional development * Wellness programs that promote a healthy work-life balance * Flexible Spending Account - Health Care/Childcare * CalPERS retirement * 457(b) option with a contribution match * Paid life insurance for employees * Pet care insurance Education & Requirements * A minimum of two (2) years of experience performing medical reviews of medical records and claims in a healthcare setting * Bachelor's degree in Medical Billing/Medical Coding, Nursing, Healthcare Administration, or related field from an accredited institution required * In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position * This experience is in addition to the minimum years listed in the Experience Requirements above * Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or Certified Coding Specialist (CCS) required * One of the following licenses preferred: * Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians * Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN Key Qualifications * Must have a valid California Driver's license * Strong understanding of medical coding, billing practices, and healthcare regulations * Thorough understanding of ICD, CPT, HCPCS, DRG, revenue codes, NDC's and other guidelines and general understanding of investigative processes within a healthcare environment are required * Knowledge of Medi-Cal and Medicare rules and regulations, and managed care in California is preferred * Strong verbal and written communication, interpersonal skills, critical problem-solving skills, and attention to detail * Above average proficiency in the use of technology applications, particularly Excel, Word, and others as necessary * Detail-oriented with strong organizational and time management abilities. Ability to articulate medical review findings clearly and thoroughly * Conduct research in support of medical reviews and make determinations on claims with a high level of accuracy * Demonstrated ability to interpret and analyze healthcare data and records * Adapt to different technology software and platforms, including anti-fraud solutions * Ability to work independently and collaboratively with a team Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range * $71,572.80 USD Annually - $93,038.40 USD Annually

At Zelis, we Get Stuff Done. So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients. A Little About You You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are. Position Overview As part of the Price Optimization division, this role is responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG Quality Assurance reviews in an effort to increase the savings achieved for Zelis clients. Conduct reviews on inpatient DRG claims as they compare with medical records utilizing ICD-10 Official Coding Guidelines, AHA Coding Clinic evidence based clinical criteria and client specific coverage policies. What you'll do: Perform comprehensive inpatient DRG validation Quality Assurance reviews to determine accuracy of the DRG billed, based on industry standard coding guidelines and the clinical evidence supplied by the provider in the form of medical records such as physician notes, lab tests, images (x-rays etc.), and with due consideration to any applicable medical policies, medical best practice, etc. Implement and conduct quality assurance program to ensure accurate results to our clients Manage assigned claims and claim report, adhering to client turnaround time, and department Standard Operating Procedures Serve as the Subject Matter Expert on DRG validation to team members and other departments within the organization Prepare and conduct training for new team members Identify new DRG coding concepts to expand the DRG product Meet and/or exceed all internal and department productivity and quality standards Must remain current in all national coding guidelines including Official Coding Guidelines, AHA Coding Clinic and AMA CPT Assistant Recommend efficiencies and process improvements to improve departmental procedures Maintain awareness of and ensure adherence to Zelis standards regarding privacy What you'll bring to Zelis: Registered Nurse licensure preferred Inpatient Coding Certification required (i.e., CCS, CIC, RHIA, RHIT) 5+ years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims preferred Solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs Strong understanding of hospital coding and billing rules Clinical and critical thinking skills to evaluate appropriate coding Strong organization skills with attention to detail Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships. Demonstrated thought leadership and motivation skills, a self-starter with an ability to research and resolve issues Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future. Location and Workplace Flexibility We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies. Base Salary Range $95,000.00 - $127,000.00 At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role. Zelis' full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees' health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage. Equal Employment Opportunity Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all. Accessibility Support We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email ***************************. Disclaimer The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.

Job Category: Revenue Cycle Work Shift/Schedule: Varies Northeast Georgia Health System is rooted in a foundation of improving the health of our communities. The Coding Quality Reviewer II is responsible for performing quality analysis of coded medical records, documenting the analysis, summarizing the metrics and reporting quality statistics to management. Responsible for complex multi-specialty coding to include but not limited to: Neurosurgery, UI, Neurology, Critical Care, hospitalists, surgical and others as defined. The Coding Quality Reviewer II is also responsible for communicating identified issues to coding staff and management, as well as reviewing and correcting coding issues from the EMR and PMS systems. In addition, the Coding Quality Reviewer II may be called upon to provide education to staff and clients, prepare coding audits for physician education, and/or coding charts as business needs dictate. The Coding Quality Reviewer II is responsible for providing and ensuring accurate, complete and timely coding of professional services to include all surgical and inpatient services. All coding staff must ensure accuracy and compliance with regulatory standards. Coding Quality Reviewer II is also responsible for performing audits in accordance with NGPG's annual Compliance Work Plan and preparing written and oral communications to the Coding Compliance Manager. Minimum Job Qualifications Licensure or other certifications: CPC and/or CCS-P Coding Certification required Educational Requirements: High School Diploma or GED Minimum Experience: Three (3) years experience coding Multi-Specialty records required. Other: Preferred Job Qualifications Preferred Licensure or other certifications: Preferred Educational Requirements: Preferred Experience: Other: Job Specific and Unique Knowledge, Skills and Abilities Extensive knowledge of ICD-9, CPT, HCPCS coding, medical terminology, federal and state regulatory guidelines and third party payor requirements required Accuracy and attention to detail imperative Ability to interact well with others at all levels with a flexible, energetic, proactive and positive style In-depth knowledge of Optimal coding policy and procedures Highly skilled proficient with Microsoft Office products Ability to communicate (both verbally and written) technical coding information to both technical and non-technical audiences Ability to organize data and provide detailed reporting Ability to prepare presentations and present to large or small audiences Must be highly motivated, detail oriented individual Excellent written and oral communication skills Problem solving and analytical skills Ability to be a self starter/work independently and as a team player Ability to travel to NGHS/NGPG sites as needed Essential Tasks and Responsibilities Perform timely, concurrent quality review of coded medical records. Correct errors identified in the quality process in both EMR and PMS systems. Maintain coding quality statistics and provide detailed reporting to management. Communicate errors to the Posting, Clinicians and AR staff on an individual basis. Communicate to management any problem areas identified in the quality process and steps taken to resolve. Assist with the review and correction of coding errors in the billing process (TM queues). Assist with the review and correction of coding errors in the electronic claims process (clearinghouse on-line errors). Promptly and professionally respond to both verbal and written coding questions from the internal staff and other areas of the company. Review documentation deficiencies for accuracy and communicate identified errors to the coding staff and management. Prepare documentation audits as needed for on-site physician education. Production coding of medical records as per business needs. Adherence to Coding policy and procedures. Review charge slips/cards for completeness (providers are ultimately responsible for codes they assign). Attends Regional and Local sponsored in-services and/or continuing education. Participates in professional development activities and maintains professional affiliations as necessary. Provide and/or validate CPT, ICD-9-CM and HCPCS coding of professional services for outpatient clinics, outreach offices or programs, minor diagnostic procedures, and/or ancillary services. Review charge tickets for missing or inaccurate information. Items reviewed include service and diagnosis codes units of service, modifiers, facility code, place of service, provider billing numbers, etc. Communicate with providers and clinic staff to ensure charge capture of all professional services, supplies, drugs, vaccinations, etc. Monitor reconciliation procedures to ensure all charges are captured and billed in a timely manner. Research and correct claims manager edits in a timely manner by applying coding and carrier specific guidelines while maintaining compliance initiatives. Provide coding coverage to other specialties, departments, divisions, and/or units as required. Attend billing educational sessions to enhance coding knowledge i.e. American Academy of Professional Coders, Professional Medical Coding Curriculum, NGPG Compliance Proficiency training, specialty seminars. Performs other job duties as assigned. Cross trains in other positions as requested. Physical Demands Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time Weight Carried: Up to 20 lbs, Occasionally 0-30% of time Vision: Moderate, Frequently 31-65% of time Kneeling/Stooping/Bending: Occasionally 0-30% Standing/Walking: Occasionally 0-30% Pushing/Pulling: Occasionally 0-30% Intensity of Work: Frequently 31-65% Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding, Driving Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals. NGHS: Opportunities start here. Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.

Full-time Description Employee is a Lead Bill Reviewer who will assist the Bill Review Supervisor in a variety of functions related to the ultimate goals of the department. Candidate's commute to the nearest office location is more than 50 miles Candidate must show exemplary productivity and performance Candidate must report to the closest office as needed for personnel meetings and training and/or as supervisor requests (at a minimum, once a month). Live in a location that can receive an approved high speed internet connection Have a “meets” or “exceeds” performance rating on most current performance review and currently meeting all performance expectations. Employee must not have an open Corrective Action Plan. Under close supervision, meets daily production quotas in processing and auditing medical bills in accordance with the appropriate workers' compensation fee schedule by performing the following duties. Essential Duties and Responsibilities: Must be able to process all clients' bills to serve as a team backup for all clients. Must be able to serve as a backup to the Bill Review Supervisor in day to day operations. Non-exempt employees must log all time worked in the Paylocity system including log-in and log-off time as well as lunch time. Codes medical bills into the company system with speed and accuracy, maintaining company production standards related to quantity and quality of output. Performs preliminary screening for appropriateness and medical necessity of services rendered. Uses CPT and ICD-10 codes, fee schedules, and other resource materials to determine appropriate reimbursement of billed services, including applicable fee schedule and/or repricing rational. Flags any problem bills. Communicates with clients and/or providers to clarify information Assists with bill review reporting functions (internal and external reports) May specialize in state specific or client specific areas of responsibility May assist is answering provider calls. May travel to other offices to assist with training May be called upon to assist with sales and marketing presentations Requirements Competency: To perform the job successfully, an individual should demonstrate the following competencies: Design - Demonstrates attention to detail. Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions. Team Work - Supports everyone's efforts to succeed. Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickl Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Excellent oral and written communication skills. Education and/or Experience: High school diploma or general education degree (GED), plus minimum of one year data entry/medical billing experience; additional two years bill review experience in a workers' comp environment. We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records. Salary Description $25.00 - $30.00

At Zelis, we Get Stuff Done. So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients. A Little About You You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are. Position Overview At Zelis, the Itemized Bill Review Facility Reviewer is responsible for analyzing facility inpatient and outpatient claims for Health Plans and TPA's to ensure adherence to proper coding and billing guidelines. They will work closely with Expert Claim Review and Concept Development staff to efficiently identify billing errors and adhere to policies and procedures for claims processing. This is a production-based role with production and quality metric goals. What you'll do: * Conduct detailed review of hospital itemized bills for identification of billing and coding errors for all payor's claims * Contribute process improvement and efficiency ideas to team leaders and in team meetings * Translate client reimbursement policies into Zelis coding and clinical concepts * Understand payor policies and their application to claims processing * Prepare and upload documentation clearly and precisely identifying findings * Accurately calculate/verify the value of review and documentation for claim processing * Monitor multiple reports to track client specific requirements, turnaround time and overall claims progression * Maintain individual average productivity standard of 10 processed claims per day * Consistently meet or exceed individual average quality standard of 85% * Ability to manage a variety of claim types with charges up to $500,000 * Collaborate between multiple areas within the department as necessary * Follow standard procedures and suggest areas of improvement * Remain current in all national coding guidelines including Official Coding Guidelines and AHA Coding Clinic and share with review team * Maintain awareness of and ensure adherence to Zelis standards regarding privacy What you'll bring to Zelis: * CPC credential preferred * 1 - 2 years of applicable healthcare experience preferred * Working knowledge of health/medical insurance and handling of claims * General knowledge of provider claims/billing, with medical coding and billing experience * Knowledge of ICD-10 and CPT coding * Ability to manage and prioritize multiple tasks * Attention to detail is essential * Accountable for day-to-day tasks * Excellent verbal and written communication skills * Proficient in Microsoft Office Suite Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future. Location and Workplace Flexibility We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies. Base Salary Range $59,000.00 - $79,000.00 At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role. Zelis' full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees' health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage. Equal Employment Opportunity Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all. Accessibility Support We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email ***************************. Disclaimer The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.

At Zelis, we Get Stuff Done. So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients. A Little About You You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are. Position Overview As part of the Price Optimization division, this role is responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG Quality Assurance reviews in an effort to increase the savings achieved for Zelis clients. Conduct reviews on inpatient DRG claims as they compare with medical records utilizing ICD-10 Official Coding Guidelines, AHA Coding Clinic evidence based clinical criteria and client specific coverage policies. What you'll do: Perform comprehensive inpatient DRG validation Quality Assurance reviews to determine accuracy of the DRG billed, based on industry standard coding guidelines and the clinical evidence supplied by the provider in the form of medical records such as physician notes, lab tests, images (x-rays etc.), and with due consideration to any applicable medical policies, medical best practice, etc. Implement and conduct quality assurance program to ensure accurate results to our clients Manage assigned claims and claim report, adhering to client turnaround time, and department Standard Operating Procedures Serve as the Subject Matter Expert on DRG validation to team members and other departments within the organization Prepare and conduct training for new team members Identify new DRG coding concepts to expand the DRG product Meet and/or exceed all internal and department productivity and quality standards Must remain current in all national coding guidelines including Official Coding Guidelines, AHA Coding Clinic and AMA CPT Assistant Recommend efficiencies and process improvements to improve departmental procedures Maintain awareness of and ensure adherence to Zelis standards regarding privacy What you'll bring to Zelis: Registered Nurse licensure preferred Inpatient Coding Certification required (i.e., CCS, CIC, RHIA, RHIT) 5+ years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims preferred Solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs Strong understanding of hospital coding and billing rules Clinical and critical thinking skills to evaluate appropriate coding Strong organization skills with attention to detail Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships. Demonstrated thought leadership and motivation skills, a self-starter with an ability to research and resolve issues Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future. Location and Workplace Flexibility We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies. Base Salary Range $95,000.00 - $127,000.00 At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role. Zelis' full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees' health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage. Equal Employment Opportunity Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all. Accessibility Support We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email ***************************. Disclaimer The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.

At Zelis, we Get Stuff Done. So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients. A Little About You You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are. Position Overview The ECR Dispute Reviewer is responsible for conducting comprehensive clinical reviews of medical records, claims, and other healthcare documentation to ensure compliance with clinical guidelines, regulatory requirements, and organizational policies. This individual will play a critical role in supporting the quality and integrity of our clinical review processes, providing expert guidance, and contributing to the continuous improvement of our healthcare services. The ideal candidate will have extensive clinical experience, strong analytical skills, and a deep understanding of healthcare regulations and standards. What you'll do: * Conduct detailed clinical reviews of medical records, claims, and other healthcare documentation to assess the appropriateness of care, medical necessity, and compliance with clinical guidelines. * Evaluate the accuracy and completeness of clinical documentation, identifying any discrepancies or areas for improvement. * Provide expert clinical judgment and recommendations based on evidence-based guidelines and best practices. * Ensure that clinical reviews are conducted in accordance with relevant regulatory requirements, accreditation standards, and organizational policies. * Stay up to date with changes in healthcare regulations, guidelines, and industry standards, and incorporate them into the review process. * Assist in the development and implementation of policies and procedures to ensure compliance with regulatory requirements. * Participate in quality assurance activities, including audits, peer reviews, and performance evaluations, to ensure the accuracy and consistency of clinical reviews. * Identify opportunities for process improvements and contribute to the development and implementation of quality improvement initiatives. * Provide training and mentorship to junior clinical reviewers and other team members to enhance their clinical review skills and knowledge. * Collaborate with healthcare providers, case managers, and other stakeholders to obtain additional information and clarify clinical documentation as needed. * Communicate review findings and recommendations to internal and external stakeholders in a clear and concise manner. * Participate in interdisciplinary team meetings, case conferences, and other collaborative activities to support coordinated care and decision-making. * Maintain accurate and thorough documentation of clinical review activities, findings, and recommendations in the appropriate systems. * Prepare and present reports on clinical review outcomes, trends, and performance metrics to management and other stakeholders. * Contribute to the development of clinical review guidelines, protocols, and educational materials. What you'll bring to Zelis: * Bachelor's degree in Nursing, Medicine, or a related healthcare field, or equivalent experience required. A Master's degree or higher is preferred. * Current and unrestricted clinical licensure (e.g., RN, MD, DO) is preferred. * Minimum of 8 + years of clinical experience in a healthcare setting, with a strong background in clinical review, utilization management, or quality assurance. * Extensive knowledge of clinical guidelines, medical necessity criteria, and healthcare regulations (e.g., CMS, NCQA, URAC). * Experience in conducting clinical reviews and audits, with a proven track record of accuracy and attention to detail. * Strong analytical and critical-thinking skills, with the ability to interpret complex clinical information and make sound clinical judgments. * Excellent verbal and written communication skills, with the ability to convey clinical findings and recommendations clearly and professionally. * Proficiency in using clinical review software, electronic health records (EHR), and Microsoft Office Suite. * Ability to work independently and collaboratively in a fast-paced, dynamic environment. * Detail-oriented and highly organized, with the ability to manage multiple tasks and priorities simultaneously. * Proactive and self-motivated, with a strong sense of ownership and accountability. * Committed to continuous learning and professional development, with a passion for improving healthcare quality and outcomes. Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future. Location and Workplace Flexibility We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies. Base Salary Range $95,000.00 - $127,000.00 At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role. Zelis' full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees' health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage. Equal Employment Opportunity Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all. Accessibility Support We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email ***************************. Disclaimer The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.