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1. Coding Compliance Analyst UnitedHealth Group Salary: $23.89 - $42.69. As a Coding Compliance Analyst, you will be responsible for procedure and diagnostic coding of professional charges. Works closely with clinical department physicians and staff to ensure accurate and compliant coding and maximization of revenue through initial coding. Schedule (FT, 40 hours): Will work 8-hr shifts, Monday-Friday. Must be flexible with schedule changes depending on business need. Typical business hours range from 6am - 6pm. (Preferably EST or CST). https://careers.unitedhealthgroup.com//job/worcester/coding-compliance-analyst/34088/92967059136
2. Clinical Denials and Appeals Registered Nurse Guidehouse. Salary: $68,000 - $113,000. Conduct pre‑ and post‑service medical necessity reviews for inpatient, observation, and outpatient hospital encounters using evidence‑based criteria such as InterQual and Milliman Care Guidelines. Perform retrospective medical record reviews to validate completeness and accuracy of physician and clinical documentation supporting level of care and services rendered. Identify denial root causes and determine appeal viability based on payer policies, regulatory guidance, and clinical standards. Prepare, submit, and track clinical appeals, including written appeals. Collaborate with Patient Access, Case Management, Utilization Management, Coding, and Mid‑Revenue Cycle teams to resolve denials and prevent recurrence. Research and apply payer‑specific policies, CMS regulations, and contractual language to support appeal arguments. Track and report denial and appeal outcomes, identify trends, and provide recommendations for process improvement and staff education. Maintain accurate documentation of all review activities in hospital and payer systems in accordance with compliance standards. https://guidehouse.wd1.myworkdayjobs.com/en-US/External/details/Clinical-Denials-and-Appeals-RN_40382-1?q=nurse
3. Clinical Appeals Specialist Asante. Salary: $36.79 - $50.59. The Clinical Appeals Specialist is responsible for managing clinical denials by conducting a comprehensive review of clinical documentation and formulating a timely and defensible written response based on clinical documentation, evidence based medical necessity criteria, physician documentation and medical policies of the payor. Communicates identified denial trends and patterns to the Manager of Patient Accounting, the Director of Revenue Cycle and all applicable patient accounting leaders. Works to review, evaluate and improve the enterprise clinical denial and appeal process. At the direction of the Manager of Patient Accounting, this individual will orchestrate education and other performance improvement initiatives to impact clinical quality, improve efficiency and mitigate lost revenue related to medical necessity denials. https://css-asante-prd.inforcloudsuite.com/hcm/Jobs/form/JobPosting%5BJobPostingSet%5D%284000,26462,1%29.JobPostingDisplay?navigation=JobPosting%5BJobPostingSet%5D%284000,26462,1%29.JobPostingDisplayNav&csk.JobBoard=EXTERNAL&csk.HROrganization=4000
4. Payment Processor Accounting Associate EXL Salary: $55,000 - $60,000. Reconcile client's bank accounts. Reconcile client's suspense accounts and provide supporting inventory. Oversee day to day inbound and outbound cash transactions for life and annuity products. Perform day-to-day suspense and bank matching. Adhere to standard operation control for audits. Troubleshoot, assist, resolve issues and recommend process improvements. Journalize adjustments or approved miscellaneous correction. Adhere to appropriate handling of sensitive information. Develop procedures and controls to adhere to standard operation audits. Maintain client's standard level agreement. Prepare Unclaimed property reporting. Ensure Unclaimed property adheres to client's requirements. Support Tax Reconciliation and remittances to Federal and State agencies. https://fa-ewjt-saasfaprod1.fa.ocs.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_2/job/16763
5. Teamcenter Quality Solution Architect Capgemini Salary: $88,544 - $207,401, We are seeking an experienced Solution Architect with deep expertise in Teamcenter Quality (QMS) and Teamcenter Product Configurator (Variant Configuration) to lead the design and implementation of integrated PLM solutions. This role is responsible for defining scalable architecture connecting quality processes(to lead the design and implementation of Quality module solutions (APQP, CAPA, Quality Hub, Supplier Connect), product configuration, and digital thread, ensuring end-to-end traceability from requirements through manufacturing and service. https://www.capgemini.com/jobs/512252-en_US_SAPBTP#Southfield%2C%20MI
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