Researches the substance of complex appeal or retrospective review requests including pre pay and post payment review appeal requests. Provides thorough clinical review or benefit analysis to determine if the requested services meet medical necessity guidelines. Documents decisions within mandated timeframes and in compliance with applicable regulations or standards. Perf

Prepares patient admission packets. Processes orders, 485s, and face to face documentation. Ensures all documents are uploaded to the EMR on a timely basis. Manages and processes documentation for care center including, but not limited to, orders, paper visit notes, discharge, transfer and episode summaries and medication profiles. Responsible for security and maintenance

Internal Reference Number 30109606 Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we're stronger than ever. Our A.M. Best

Health Information Specialist I Job Locations US SC Columbia Requisition ID 2024 36102 # of Openings 1 Category (Portal Searching) Operations Position Type (Portal Searching) Employee Full Time Overview Who we are... Datavant protects, connects, and delivers the world's health data to power better decisions and advance human health. We are a data logistics company for hea

Thoroughly review and analyze facility inpatient medical records to identify pertinent diagnoses, procedures, and treatments. Accurately assign ICD 10 CM and PCS codes to precisely reflect clinical documentation. Ensure the integrity and precision of coded data, including meticulous DRG assignment verification. Stay abreast of evolving coding guidelines, regulations, and

Medical Office Support Job ID 2024 26919 # Positions 1 Job Location US SC Columbia Telecommute Location Specific Position FT/PT Full Time Category Medical Office Professionals Why Us? With a mantra of Empowering Human Potential, Hanger, Inc. is the world's premier provider of orthotic and prosthetic (O&P) services and products, offering the most advanced O&P solutions, cl

Provides remote medical records coding and abstracting services to our clients nationwide; and Work remotely from a home office. LexiCode Offers Med, Dental, Vision, Rx, 401k, PTO and Holidays, STD, LTD for FT employees Flexible Schedules Excellent hourly compensation Computer with dual monitors and Encoder $3,000.00 Referral bonuses Remote education platform, with traini

Provides education to medical providers as warranted. Description What You'll Do Communicates/educates providers on issues such as Medicare coverage, utilization statistics, documentation and medical review by use of written advisories, reports, letters, and telephone contacts. Documents all provider contacts/communications in provider tracking system. Conducts formal con

This expert level senior inpatient coder is responsible for leading coding teams, coder training, work que management, performing prebill and second level coding reviews utilizing auditing software and documents findings to improve CC/MCC capture, Risk Variable capture, HAC/PSI, HCC and Quality Indicator validation. The coding analyst will use their knowledge of coding an

Include Ensure patient demographic information is accurate and complete Utilize customer hospital systems or approved vendors to research and obtain/verify patient demographic information Validate signature documents such as AOB (Assignment of Benefits), consents, CMN (Certificate of Medical Necessity) Verify patient name is consistent on all documents Verify date of servi

The purpose of this job is to handle time consuming clerical responsibilities for physicians during office based patient encounters. Scribes accompany a physician and directly observe patient encounters. They accurately document the events and decision making in a manner that results in appropriate medical charting. Scribes also complete clerical activities necessary to a

Responsible for validating/reviewing and assigning applicable CPT, ICD 10, Modifiers and HCPCS codes for inpatient, outpatient and physicians office/clinic settings. Adheres to all coding and compliance guidelines. Maintains knowledge of coding/billing updates and payer specific coding guidelines for multi specialty medical practice(s). Communicates with providers and tea

Receives and interviews patients to collect and verify pertinent demographic and financial data. Verifies insurance and initiates pre authorization process when required. Collects required payments or makes necessary financial arrangements. Performs all assigned duties in a courteous and professional manner. May perform business office functions. Accountabilities Intervie

Under the direction of the department Manager, coordinates timely, comprehensive charge reconciliation for Perioperative Services. Performs internal charge audits and assists supervisor in overseeing the Chargemaster for assigned enterprise wide departments. Coaches staff regarding coding and billing issues. Reviews escalated accounts and issues providing coding expertise

The purpose of this job is to handle time consuming clerical responsibilities for physicians during office based patient encounters. Scribes accompany a physician and directly observe patient encounters. They accurately document the events and decision making in a manner that results in appropriate medical charting. Scribes also complete clerical activities necessary to a