• Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement. • Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers. • Collaborate with team leaders to ensure thorough review of DRG denials. • Conduct audits in alignment with organizational quality and timeliness standards. • Use proprietary auditing systems proficiently to make consistent determinations and generate audit letters. • Recommend improvements to the audit system to enhance efficiency. • Ensure compliance with HIPAA regulations for protected health information. • Perform other duties as assigned.

Role Description CS - Connect is looking for full-time Primary Care Physicians who will deliver fully remote, video-based, comprehensive clinical care encompassing preventive care, sick visits, and chronic condition management. The ideal candidate must be licensed in CA, have a board certification in Family Medicine, and be comfortable practicing the full spectrum of primary care, including pediatrics and mental health. Work from the comfort of your home and deliver care to those who need it the most, supported by K Health's cutting-edge Clinical AI Platform. Our virtual clinic is fully supported 24/7 by a dedicated team of Care Concierge, Clinical Operations, and technical support staff, which helps significantly reduce your administrative burden. - Provide high-quality preventative, acute, and chronic care in a fully remote, virtual setting - Elevate remote care by providing compassionate and meaningful patient encounters - Manage a dedicated panel of patients as their primary care physician - Refer patients to specialists or acute care services when clinically indicated - Work on population health initiatives for risk-attributed patients (AWVs, care gaps, transitions of care, risk capture) - Support patients immediately post-discharge to improve understanding of treatment plans and reduce hospital readmissions - Practice continuous self-evaluation to ensure adherence to clinical guidelines and best practices Qualifications - Licensed in California - Board certification in Family Medicine - Comfortable practicing the full spectrum of primary care, including pediatrics and mental health Benefits - Malpractice insurance coverage - Work from anywhere in the US - Generous Paid Time Off - Paid parental leave - 401k benefit - Competitive health, dental, and vision insurance options - CME Allowance $2000 Annually - Pay Range: $250,000 - $312,000 Total Cash Compensation Company Description Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine, and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching, and community service. Today, Cedars-Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents. With a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinai’s medical network serves people near where they live. Delivering coordinated, compassionate healthcare, you can join our network of clinicians and physicians to improve the healthcare of people throughout Los Angeles and beyond.

Discover. Achieve. Succeed. #BeHere Location: US:WI:MILWAUKEE at our FROEDTERT HOSPITAL facility. This job is REMOTE. FTE: 1.000000 Standard Hours: 40.00 Shift: Shift 1 Shift Details: Monday - Friday, No holidays or weekends. Job Summary: The Clinical Documentation Specialist Associate is an experienced staff nurse who applies their patient care knowledge and learns about all patient care populations across the enterprise to perform basic Clinical Documentation Integrity (CDI) with oversight from experienced CDI nurses. Facilitates modifications to clinical documentation to ensure appropriate reimbursement is received for the level of service rendered. Ensures the accuracy and completeness of clinical information used for measuring and reporting clinical and quality outcomes. EXPERIENCE DESCRIPTION: A minimum of 5 years of acute care nursing experience is required. EDUCATION DESCRIPTION: Bachelor Degree in Nursing or Foreign trained medical graduate is required. SPECIAL SKILLS DESCRIPTION: Efficient use of MS Office products (Excel, Outlook, Word), WebEx and Epic (or similar EMR). Excellent communication, negotiation, troubleshooting, and presentation skills. Ability to read and correlate an extensive variety of medical / surgical medical treatments and monitoring to clinical conditions. LICENSURE DESCRIPTION: Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact). Compensation, Benefits & Perks at Froedtert Health Pay is expected to be between: (expressed as hourly) $34.00 - $52.70. Final compensation is based on experience and will be discussed with you by the recruiter during the interview process. Froedtert Health Offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following: - Paid time off - Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities - Academic Partnership with the Medical College of Wisconsin - Referral bonuses - Retirement plan - 403b - Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics - Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation. We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. We welcome protected veterans to share their priority consideration status with us at 262-439-1961. We maintain a drug-free workplace and perform pre-employment substance abuse testing. During your application and interview process, if you have a need that requires an accommodation, please contact us at 262-439-1961. We will attempt to fulfill all reasonable accommodation requests.

Description Medical BillerAffiliate Wide (Buffalo, Rochester, or Syracuse, NY) Planned Parenthood of Central and Western New York (PPCWNY) protects and provides health care and education that empowers individuals and families. With respect. Without judgment. No matter what. In support of PPCWNY’s mission, the Medical Biller II has the overall responsibility to ensure effective billing and collections on all patient accounts. Essential Functions - Reviews all Tasks assigned to the individual/workgroup. - Aggressively follows up on all unpaid accounts to ensure that the A/R benchmark targets are met or exceeded. - Answers patient calls and address questions related to insurance and patient responsibility. - Works in conjunction with other staff to successfully meet internal goals. - Performs all duties in accordance with established agency policies, protocol and the In This Together services ethos, workplace values, and service standards. - Notifies Billing Manager of any collection or workflow issues. - Shows respect to all internal and external customers for differences in backgrounds, lifestyles, viewpoints and needs Requirements QualificationsApplicants must possess the following qualifications (or equivalent combination of education and experience): Education - Associate’s degree in business, accounting, business administration, or a related field or equivalent combination of education and experience Experience - Minimum three years of experience in medical billing/collections - Minimum three years of experience with computerized billing/receivables system and reports - Experience with EPIC preferred Certifications - Ideal candidate will have one of the following certifications, but is not required: Registered Health Information Administrator (RHIA), Certified Health Information Technician (CHIT), Certified Coding Specialist (CCS), Certified Medical Billing Specialist (CMBS), or Certified Professional Coder (CPC) Knowledge, Skills, & Abilities - Must be sensitive to patient’s financial and clinical needs while maintaining the patient’s confidentiality - Experience in insurance guidelines and programs (i.e., Medicaid and Medicare) - Knowledge of ICD-9/10, HCPCS and CPT codes - Extensive experience with follow-up on unpaid claims within standard billing cycle timeframes - Extensive experience with appealing insurance companies for denied claims - ERA payment posting experience - Must be able to multi-task and work in a fast-paced environment effectively under deadlines - Accuracy and attention to detail is essential - Extensive experience in researching issues and providing resolutions - Strong analytical and problem-solving skills - Must be able to work independently and as a team player - In-depth knowledge of Government and non-Government payer sources - Experience working with databases and Microsoft Office (i.e., Excel and Word) - Ability to work a flexible schedule (i.e., early mornings and evenings) - Must have top-notch customer service and follow-up skills - Ability to read and interpret medical procedures and terminology - Planned Parenthood seeks candidates who are proficient in two or more languages Working Conditions - Standard health center environment - Well-lit/ventilated Physical Requirements - Possess sufficient mobility to perform the Essential Functions listed in this Job Description with or without an accommodation - Ability to lift 25 pounds with or without an accommodation - May experience visual fatigue working at computer with potential extended periods of sitting - Ability to travel to all agency locations as assigned Work Schedule This is a full-time, 40 hour a week, position; regular schedule will be Monday – Friday with occasional evenings and weekends. Benefits & CompensationAt PPCWNY, we are committed to equitable compensation practices and transparency. In alignment with these efforts, the pay for this position ranges from $21.89 to $25.36/hour. Actual compensation will be determined by experience and other factors permitted by law. In addition to competitive compensation, PPCWNY offers an extensive benefits package with generous Paid Time Off, 10 paid holidays, affordable medical, dental, and vision options, Health Savings Account or Flexible Spending Account, 401(k) with match, and much more! Planned Parenthood of Central and Western New York is an equal opportunity employer.