Position Title: DRG Clinical Validation AuditorUSRN with at least 2 years of bedside experienceCandidates must have 1-2 years of hospital coding experience.One or more of the following certifications:Certified Documentation Improvement Practitioner (CDIP- AHIMA)Certified Professional Coder (CPC)Inpatient Coding Credential such as CCS (AHIMA)-IP/OPInpatient Coding Credential such as CIC (AAPC)RHIT or RHIA (preferred Certification)Certified Clinical Documentation Specialist (CCDS)
Responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims.
Primary duties may include but are not limited to:
Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities.Draws on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions.Utilizes audit tools, auditing workflow systems and reference information to generate audit determinations and formulate detailed audit findings letters.Maintains accuracy and quality standards as established by audit management.Identifies potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs).Suggests and develops high quality, high value, concept and or process improvement and efficiency recommendations.Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and coding terminology preferred.
*This ad is for external candidates only. Carelon associates can apply through our internal channel.
Responsible for providing the company with accurate and timely controls of general ledger account reconciliation's and the preparation of journal entries. Primary duties may include, but are not limited to:Assists with monthly, quarterly, annual and ad-hoc financial reporting and analysis. Prepares accounting report schedules, monthly journal entries and account reconciliations. Reviews and verifies accuracy of journal entries and accounting classifications assigned to various records. Coordinates accounting matters with other departments, locations and divisions. Requires a BS/BA; or any combination of education and experience, which would provide an equivalent background. BS/BA in Accounting or Finance preferred. 3 years directly related experience preferred.
We are seeking a detail-oriented Public Relations professional to support strategic communications initiatives through high-quality presentation development, project management, and media coverage analysis. This role plays a critical part in ensuring communications materials are visually compelling, projects stay on track, and media impact is accurately measured and reported. Key Responsibilities: PowerPoint Slide Design & Production • Design, build, and maintain polished PowerPoint presentations for executive briefings, client meetings, media pitches, and internal communications • Translate complex information into clear, visually engaging slides that align with brand and messaging standards • Manage multiple presentation projects under tight deadlines while ensuring accuracy and consistency
Project Management • Coordinate PR initiatives across internal teams, vendors, and external partners • Develop and manage timelines, deliverables, and status updates to ensure projects are completed on time and within scope • Track progress, identify risks, and proactively address issues to keep projects moving forward
Media Coverage Research & Analysis • Monitor and analyze media coverage across print, digital, broadcast, and social channels • Compile media reports, coverage summaries, and performance metrics • Identify trends, insights, and opportunities to inform PR strategy and storytelling
Responsible for providing the company with accurate and timely controls of general ledger account reconciliation's and the preparation of journal entries. Primary duties may include, but are not limited to: Assists with monthly, quarterly, annual and ad-hoc financial reporting and analysis. Prepares accounting report schedules, monthly journal entries and account reconciliations. Reviews and verifies accuracy of journal entries and accounting classifications assigned to various records. Coordinates accounting matters with other departments, locations and divisions.
Qualifications:Requires a BS/BA; or any combination of education and experience, which would provide an equivalent background.BS/BA in Accounting or Finance preferred3 years directly related experience preferred
Job Summary:
Responsible for all facilities management of the assigned site Primary duties may include but are not limited to:
Ensures the physical infrastructure of the business is operational. Identifies areas for greater efficiency and cost-saving. May support other sites as needed. Oversees and coordinates all building systems (i.e. HVAC, mechanical, electrical, fire protection, etc.) and other facilities-related systems to support the business (i.e. structured cabling, furniture & fixtures reconfiguration, etc.). Manages operational and capital budgets and develops and monitors cost-efficient programs. Conducts reviews of all service providers. Ensure Emergency Preparedness for the sites and provide support for Business Continuity Planning (BCP). Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Qualifications:Bachelor’s degree in Electrical, Mechanical, or Civil engineering5 years of relevant experience, including prior people management experience, or an equivalent combination of education experienceHas a Pollution Control Officer (PCO) CertificationExperience in the BPO industry, with strong knowledge of industry standards, building systems, and controls, is required
Responsible for supporting Procurement. Responsible for leading best practice and expense management business analysis efforts that cover the full breadth of the company. Primary duties may include, but are not limited to:Designs and develops data capturing and reporting approaches as well as identifying possible areas of opportunity for expense management improvement.Reviews and analyzes Corporate Purchasing processes and procedures.Defines current work flow, performance metrics, relationships among commodities and processes. Assesses leverage opportunities across organization.Responsible for the execution and implementation of traditional, sub-category sourcing strategies. Executes standardized strategic sourcing processes for assigned sub-categories.Builds and maintains strong working relationships with internal customers and key suppliers for sub-categories. Focuses on cost savings.Participates in cross-enterprise commodity teams for sub-categories and aggressively tracks and improves non-compliance preferred supplier(s).Participates in fact-based negotiations and executes contracts utilizing approved terms and conditions. Implements sourcing recommendations and develops and manages e-procurement catalog content.Aggressively monitors, tracks and reports supplier compliance and performance benefits. Requires a BA/BS; 6 years of experience in sourcing/supplier selection with at least 4 years experience with negotiation of pricing and contract terms and conditions; or any combination of education and experience, which would provide an equivalent background. MBA preferred. CPM preferred.
Responsible for providing oversight of Shared Services Associates and Managers. Primary duties may include but are not limited to: responsible for establishing departmental policies and procedures. Leads the MaaS Business Development for PH including rate card development and analysis for existing and new Capabilities. Accountable for stakeholder management for the different MaaS functions and establishment and review of performance goals.
Serves as mentor to lower leveled managers; serves as subject matter expert for other areas of the company as well as within the department; has accountability for deliverables of a third party or vendor; manages multiple functions requiring unique sets of knowledge or has significant fiscal accountability over and above routine people/equipment costs; develops and manages annual operating budget; may be assigned to special project work consistent with the role and as dictated by the needs of the business; audits to monitor efficiency and compliance with policies; prepares specialized reports. Hires, trains, coaches, counsels and evaluates performance of direct reports.
Requires BA/BS; 2-3 years previous management experience and 5 years customer service experience; or any combination of education and experience, which would provide an equivalent background.
• Responsible for serving as the operations point of contact for Medical Management and /or Medical Coding day to day operations, including but not limited to, facilitating issue resolution, meeting goals and targets. • Primary duties may include but are not limited to: Acts as a liaison for both internal and external groups for program initiatives. Help create, launch and drive critical account initiatives and programs. • Provides inputs to policies and processes impacting the operations. • Manages a team of nurses and/or allied Healthcare professionals in the optimal execution of operations activities ensuring that each team member meets / exceeds their goals and metrics on a daily, weekly and monthly basis. • Coordinates with workforce for staffing requirements and scheduling of agents given leaves, absences and attrition. • Prepares reports. Hires, trains, coaches, counsels, and evaluates performance of direct reports. • Suggests and develops high quality, high value, concept and or process improvement and efficiency recommendations.
Qualifications• US Registered Nurse • Certified Medical Coder (CPC; CDIP - AHIMA; CCS; CIC; CCDS) • At least 1.5 Year of handling a team of Medical Coders • People and Performance Management • Stake Holder Management • Project Management (Preferred)
Responsible for providing oversight for customer service staff. Responsible for establishing departmental policies and procedures.Primary duties may include but are not limited to: Directs implementation and administration of benefit programs. Prepares and communicates information to appropriate parties regarding benefit programs, procedures, changes and government mandated disclosures.Audits to monitor efficiency and compliance with policies; prepares specialized reports; may be assigned to special project work consistent with the role and dictated by the needs of the business. Hires, trains, coaches, counsels, and evaluates performance of direct reports
QualificationsExperience Manager role (2 Years)Experience Engagement activitiesAccount: Voice and Non-VoiceHealthcare (Preferred)Process Improvement (Preferred)Stake Holder management
Responsible for evaluating the quality of services and interactions provided by organizations within the enterprise.
Primary duties may include, but are not limited to:Evaluates the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.Tracks and trends audit results, providing feedback to management.Conduct calibration sessions to evaluate and ensure that all teams are aligned with the set QA guidelines.Identifies and reports on systemic issues which create ongoing quality concerns. Conducts root cause analysis to determine the underlying causes of noted quality opportunities using the RCA tools.Recommend, implement, and monitor preventive and corrective actions to ensure that quality standards are achieved.Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist management with information requested.Produces other ad hoc reports as requested by internal and external clients.Associates at this level conduct routine to complex audits, generally related to one or more functions on one or more systems platform for one or more lines of business.
Requires a BS Nursing degree. At least 1 year bedside and/or utilizations management experience. At least 1 year QA experience. Working knowledge of healthcare industry and medical terminology, detailed knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines; and ability to acquire and perform progressively more complex skills and tasks in a production environment required.
One or more of the ff certificates:Certified Clinical Documentation Specialist (CCDS)Certified Documentation Improvement Practitioner (CDIP)Certified Professional Coder (CPC)Inpatient Coding Credential such as CCS or CIC
