Inpatient Medical Coding Auditor Jobs

Inpatient Medical Coding Auditor — Nationwide. Apply via Workday.

Certified Inpatient Medical Coding Auditor — Remote Nationwide. Apply via Workday.

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: Ready to take your Medical Director career to the next level with a Fortune 6 company? Join Aetna, a CVS Health company, and make a meaningful impact on the health and well-being of Medicaid members across the country. Aetna operates Medicaid managed care plans in Arizona, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Texas, Virginia, and West Virginia. We are seeking a Medical Director to join our centralized Medical Management team. This work-from-home position will primarily support Aetna Better Health of Louisiana , while also providing support across the other health plans as needed. In this role, you will partner with Medical Management staff to ensure timely, consistent, and clinically sound decisions for members and providers. Key responsibilities include: Utilization Management and medical necessity reviews Prior authorization and precertification determinations Concurrent review for inpatient and outpatient services Acute and post-acute care reviews Peer-to-peer consultations with treating providers Pharmacy reviews and first-level appeal determinations Collaboration with multidisciplinary clinical and operational teams The Medical Director also participates in a rotating on-c

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Utilization Management Nurse Consultant (RN) – Concurrent Review Remote | Acute Inpatient Utilization Management | RN Opportunity Are you an experienced RN with a background in acute care and utilization management? Join our team and play a vital role in ensuring members receive appropriate, high-quality, and cost-effective inpatient care through concurrent review and care coordination. What You'll Do Perform concurrent reviews for acute inpatient admissions and continued hospital stays Evaluate medical necessity, severity of illness, intensity of service, and level of care using evidence-based clinical criteria Collaborate with hospitals, physicians, care managers, and discharge planners to support appropriate treatment and timely transitions of care Review clinical documentation and apply health plan benefits and regulatory requirements to authorization decisions Partner with Medical Directors on complex cases and escalations Facilitate discharge planning and identify opportunities to optimize care and resource utilization Manage a high-volume caseload while meeting quality, productivity, and turnaround-time standards WHAT YOU BRING - REQUIRED Active, unrestricted RN license in your state of residence Ability to obtain and maintain additional state licensure as required 5&#43

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This position is responsible for performing utilization management (UM) reviews and authorization activities for post-acute services, including Skilled Nursing Facilities (SNF), Inpatient Rehabilitation Facilities (IRF), Long-Term Acute Care Hospitals (LTACH), Home Health, and other post-acute levels of care. The UM Nurse Consultant evaluates medical necessity and appropriateness of services utilizing clinical criteria, applicable policies, and regulatory requirements to support quality, cost-effective care. The UM Nurse Consultant collaborates with providers, care managers, medical directors, and interdisciplinary teams to facilitate timely care transitions, ensure member needs are met, and support organizational goals. This role requires independent clinical judgment, strong critical thinking skills, and the ability to manage multiple priorities in a fast-paced environment. Required Qualifications Active, unrestricted Registered Nurse (RN) license in the state of residence. Ability to obtain and maintain additional state licensure as required by business needs. 3+ years of clinical nursing experience. 1+ years of utilization management, case management, discharge planning, managed care, or post-acute care experience. Experience reviewing medical records and applying evidence-based

We’re here for one reason and one reason only – to cure cancer. Every moment is dedicated to developing treatments and every action moves us one step closer to our goal. We’ve made incredible scientific breakthroughs and our pioneering personalized CAR T-cell therapies have changed the paradigm. But we're not finished yet. Join Kite, as we make even bigger advances in cancer therapies, and help shape where our business and medical science goes next. We believe every employee deserves a great leader. People Leaders are the cornerstone to the employee experience at Gilead and Kite. As a people leader now or in the future, you are the key driver in evolving our culture and creating an environment where every employee feels included, developed and empowered to fulfil their aspirations. Join Kite and help create more tomorrows. Job Description We are seeking a Medical Strategy professional to join the Global Medical Strategy team for Lymphoma and Leukemia. This role partners closely with the Global Medical Lymphoma/Leukemia lead to support the development and execution of medical strategy across the product lifecycle, including marketed products and pipeline indications. The position collaborates cross‑functionally with internal partners and external experts to ensure the generation and communication of scientific evidence that supports optimal patient outcomes in hematologic malignancies. An exciting opportunity has arisen to join the Global Medical Strategy Team for Lymphoma and Leukemia (LL). In this role, the right candidate will receive a great opportunity to be part of one of the recent most impactful medical advancements in patient care and an opportunity to work towards better outcomes for patients with hematological malignancies. <p

We’re here for one reason and one reason only – to cure cancer. Every moment is dedicated to developing treatments and every action moves us one step closer to our goal. We’ve made incredible scientific breakthroughs and our pioneering personalized CAR T-cell therapies have changed the paradigm. But we're not finished yet. Join Kite, as we make even bigger advances in cancer therapies, and help shape where our business and medical science goes next. We believe every employee deserves a great leader. People Leaders are the cornerstone to the employee experience at Gilead and Kite. As a people leader now or in the future, you are the key driver in evolving our culture and creating an environment where every employee feels included, developed and empowered to fulfil their aspirations. Join Kite and help create more tomorrows. Job Description An exciting opportunity has arisen to join the U.S. Medical Affairs Team with a focus on Lymphoma & Leukemia. In this role, you will contribute to one of the recent, most impactful medical advancements in patient care and will work towards better outcomes for patients with hematological malignancies. We are seeking a highly motivated individual to join our U.S. Medical Affairs team as an Associate Director, to support our lymphoma franchise. This role will work cross-functionally with multiple stakeholders including: Field Medical, Commercial, Market Access, HEOR/RWE and Global Medical Affairs, along with other cross-functional subject matter experts and key business partners to implement on tactics consistent with overall in-line and pipeline strategy. This position will report to the U.S. Lymphoma Medical Strategy Lead. Position will be filled and report into Foster City, CA, El Segundo, CA, T

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 122,000 colleagues serve people in more than 160 countries. JOB DESCRIPTION: About Abbott Abbott is a global healthcare leader, creating breakthrough science to improve people’s health. We’re always looking towards the future, anticipating changes in medical science and technology. Our diagnostic solutions are used in hospitals, laboratories, and clinics around the globe. The crucial information derived from our tests, instruments and informatics systems are often the first step in patient care decision making for hundreds of health conditions from heart attacks to blood disorders to infectious diseases and cancers. Working at Abbott At Abbott, you can do work that matters, grow, and learn, care for yourself and family, be your true self and live a full life. You’ll also have access to: Career development with an international company where you can grow the career you dream of. Employees can qualify for free medical coverage in our Health Investment Plan (HIP) PPO medical plan in the next calendar year. An excellent retirement savings plan with high employer contribution Tuition reimbursement, the Freedom 2 Save student debt program and FreeU education benef

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 122,000 colleagues serve people in more than 160 countries. JOB DESCRIPTION: About Abbott Abbott is a global healthcare leader, creating breakthrough science to improve people’s health. We’re always looking towards the future, anticipating changes in medical science and technology. Our diagnostic solutions are used in hospitals, laboratories, and clinics around the globe. The crucial information derived from our tests, instruments and informatics systems are often the first step in patient care decision making for hundreds of health conditions from heart attacks to blood disorders to infectious diseases and cancers. Working at Abbott At Abbott, you can do work that matters, grow, and learn, care for yourself and family, be your true self and live a full life. You’ll also have access to: Career development with an international company where you can grow the career you dream of. Employees can qualify for free medical coverage in our Health Investment Plan (HIP) PPO medical plan in the next calendar year. An excellent retirement savings plan with high employer contribution Tuition reimbursement, the Freedom 2 Save student debt program and <a target="_blank" href="https://www.abbott.com/corpnewsroom/strategy-and-strength/college-degree-for-free-its-possible-with-freeu.htm

Opportunity Overview: We are seeking a versatile and highly skilled Lead Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviews—encompassing both outpatient/professional and inpatient claims—to ensure the accuracy of code assignment, DRG/reimbursement, and to maximize overpayment identification. If you possess a CPC and/or CCS credential, expert knowledge of CPT, HCPCS, and ICD-10-CM/PCS coding guidelines, and a passion for deep analytical auditing, you will be instrumental in supporting our commitment to accurate reimbursement solutions. This opportunity requires a self-motivated individual who thrives on precision, compliance, and continuous learning in a high-growth environment What you’ll do: Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement. Conduct comprehensive outpatient and professional coding reviews to ensure accuracy in code assignment and reimbursement. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Conduct ambulatory surgery center, emergency room, observation and infusion coding reviews. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations. Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits. Meet or exceed company quality and productivity standards, including strong uphold rates for appeals. Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge. Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance. Maintain and apply superior knowledge of changes and updates to coding guidelines, reimbursement trends,

Opportunity Overview: We are seeking a versatile and highly skilled Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviews—encompassing both outpatient/professional and inpatient claims—to ensure the accuracy of code assignment, DRG/reimbursement, and to maximize overpayment identification. If you possess a CPC and/or CCS credential, expert knowledge of CPT, HCPCS, and ICD-10-CM/PCS coding guidelines, and a passion for deep analytical auditing, you will be instrumental in supporting our commitment to accurate reimbursement solutions. This opportunity requires a self-motivated individual who thrives on precision, compliance, and continuous learning in a high-growth environment What you’ll do: Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement. Conduct comprehensive outpatient and professional coding reviews to ensure accuracy in code assignment and reimbursement. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Conduct ambulatory surgery center, emergency room, observation and infusion coding reviews. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations. Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits. Meet or exceed company quality and productivity standards, including strong uphold rates for appeals. Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge. Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance. Maintain and apply superior knowledge of changes and updates to coding guidelines, reimbursement trends, and

ROLE SUMMARY The Workplace Experience Lead provides leadership, partnership, management and operational expertise to ensure approximately 2.5M sq ft of Groton, CT facilities support the advancement of the R&D pipeline. The site has the greatest concentration of specialty labs in the R&D network consisting of small molecule clinical manufacturing, GxP and non-regulated laboratories, vivarium, technical space (central utility plant) and office workspace facilities. Nearly every breakthrough therapy in the pipeline passes through Groton facilities and processes. This role will have direct oversight and accountability for the dedicated Clinical Research Unit (CRU) located in New Haven, CT and comprised of approximately 62.5K sq ft. This site is focused primarily on early-phase human clinical studies and contains 50&#43; patient inpatient beds. A critical element of the site’s performance is to ensure safe and compliant operations to meet and enable the aggressive timelines and evolving priorities of a first-in-class research organization. Therefore, making possible the delivery of commitments while providing an enabling and engaging work environment where colleagues and contractors can do their best work. ROLE RESPONSIBILITIES Serve as the primary onsite GWE point of contract for site leadership, coordinating responses, solutions, and opportunity resolutions through effective partnership for the entirety of the GWE soft services including but not limited to GMP cleaning, janitorial/housekeeping, food service, shipping and receiving, meetings and events management, churn moves and furniture, groundskeeping, pest control, snow removal, lab services and consumables, and new workplace services. Submit annual OpEx budgets for both the Groton and New Haven campuses (&#43;$11.9M) to the GWE Site Lead for review and approval and accountable for management and oversight to forecast targets. <

Become a part of our caring community Professional member of patient’s treatment team who provides skilled nursing visits in patient’s home under the direction of plan of treatment stablished with physician and input from patient/caregiver. Provides supervision for Aide and LPN as needed DUTIES AND RESPOSIBILITIES: • Provide initial and on-going assessment of client needs using the OASIS data elements incorporated into the Comprehensive Assessment. • With input from patient/caregiver and in conjunction with physician, formulates and implements plan of care. • Evaluate effectiveness of care plan and make necessary adjustments. • Provides for emotional and physical comfort and safety of client taking into consideration their rights and cultural background. • Receives and transcribes physician orders. • Notify physician and Agency supervisor of unusual reactions and/or changes in client’s condition. • Documents all appropriate observations and treatments in keeping with Agency policies and procedures. • Participates in case conferences, team meetings, staff meetings and Performance Improvement activities as assigned. • Provide supervision for Licensed Practical Nurses and/or Home Health Aide as assigned. • Provide any skilled nursing service for which appropriately trained which is prescribed under the plan of care. • Provide monthly summary of skilled services and clients outcomes to physician and Agency supervisor in keeping with Agency policies and procedures. Provides information for 60-day progress reports. • Adhere to all Agency policies and procedures including but not limited to HIPPA Privacy rule. • Maintains strict confidentiality of all patients, employee and Agency

Axsome Therapeutics is a biopharmaceutical company leading a new era in the treatment of central nervous system (CNS) conditions. We deliver scientific breakthroughs by identifying critical gaps in care and develop differentiated products with a focus on novel mechanisms of action that enable meaningful advancements in patient outcomes. Our industry-leading neuroscience portfolio includes FDA-approved treatments for major depressive disorder, agitation associated with dementia due to Alzheimer’s disease, excessive daytime sleepiness associated with narcolepsy and obstructive sleep apnea, and migraine, as well as multiple novel product candidates addressing a broad range of serious neurological and psychiatric conditions that impact over 150 million people in the United States. Together, we are on a mission to solve some of the brain’s biggest problems so patients and their loved ones can flourish. For more information, please visit us at www.axsome.com and follow us on LinkedIn and X . About This Role Axsome Therapeutics is currently searching for a field based Long-Term Care (LTC) Specialty Account Manager (SAM) to drive LTC commercial activities for an assigned geography by executing marketing strategies to ensure a successful launch and make a meaningful difference through the execution of commercial activities. SAMs will be responsible for product performance at a territory level and expected to be a disease state expert, product champion and an account specialist. The SAM will provide account management support and exhibit business knowledge of the local landscape to assess key stakeholders plus future trends within the marketplace. Job Responsibilities and Duties include, but are not limited to, the following: Drive product adoption in LTC facilities Proficient in both virtual and live customer engagements Effectively call on LTC Care teams, building meaningful relationships across the entire LTC ecosystem: Psychiatrists

Axsome Therapeutics is a biopharmaceutical company leading a new era in the treatment of central nervous system (CNS) conditions. We deliver scientific breakthroughs by identifying critical gaps in care and develop differentiated products with a focus on novel mechanisms of action that enable meaningful advancements in patient outcomes. Our industry-leading neuroscience portfolio includes FDA-approved treatments for major depressive disorder, excessive daytime sleepiness associated with narcolepsy and obstructive sleep apnea, and migraine, and multiple late-stage development programs addressing a broad range of serious neurological and psychiatric conditions that impact over 150 million people in the United States. Together, we are on a mission to solve some of the brain’s biggest problems so patients and their loved ones can flourish. For more information, please visit us at www.axsome.com and follow us on LinkedIn and X . About This Role Axsome Therapeutics is currently searching for a Regional Business Director (RBD) to lead commercial activities for an assigned geography, establish a team of Account Managers, execute marketing strategies, and ensure a successful launch. The RBD will be primarily responsible for the supervision and leadership of an industry shaping, uniquely structured salesforce leveraging the use of a highly sophisticated digital infrastructure. All sales representatives will be aligned to geographical boundaries. The RBD is responsible for sales performance at a Region level and is expected to be a product champion and exhibit the business knowledge of the local landscape to assess key stakeholders plus future trends within the marketplace. This is a cross-functional front-line leader role that will ensure successful promotion of AUVELITY for major depressive disorder in adults and potential future indications. The position is field-based and will require travel as needed to