Top 10 Clinical documentation specialist Jobs in Scranton, Pa

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Utilization Specialist
Geisinger Behavioral Health Center Northeast —Moosic, PA
Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or…
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Population Health & Operations Logistics Specialist
The Wright Center for Graduate Medical Education —Scranton, PA
Bachelor’s degree in public health, healthcare administration, health sciences, education, social sciences, or related field.

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Health Information Management Specialist
Equitas Health, Inc. —Columbus, OH
Must have reliable transportation and valid Ohio driver’s license. College coursework or vocational/technical training in nursing or another health-related…
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Documentation and Reimbursement Specialist
Nationwide Children's Hospital —Columbus, OH
Five years of experience in related field (physician billing experience), preferred. As required by listed licensure and/or certification requirement.

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clinical documentation specialist jobs near scranton, pa

Provide timely review and determination of medical claims, including prior authorization, appeals, and/or any other type of medical claims;
Provide timely review and determination of medical claims;
Analyze medical records related to the case file;
Review and interpret Local Coverage Determination (LCD), National Coverage Determination (NCD) policies, and other federal regulations;
Apply appropriate regulatory citations, including health plan policies, NCD/LCDs, and/or other regulations to each claim as it relates to the item or issue;
Formulate a narrative decision citing relevant regulatory back-up documentation contained within the medical record;
Adjudicate claim based on the regulations and documentation contained within the medical record;
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification through the American Academy of Professional Coders (AAPC) or AHIMA preferred;
Maintain professional licensure in active and unrestricted status as required by state of issuance;
Attend FHAS and/or client Lunch & Learn sessions and/or general training sessions on site as needed.
Complete IRR surveys in a timely fashion as required by the prime contractor
Maintain a 97% or higher quality score

Must possess a current, unrestricted State license as a Registered Nurse (RN),as required by contract(s).
1+ years clinical experience required; coding, utilization, and/or medical chart review preferred.
Professional Coding Certification preferred.
Detailed knowledge of Medicare regulations and guidelines, polices, and payor reimbursements preferred.
Knowledge of CPT, HCPCS, ICD-10 codes and coding guidelines.
Ability to identify Medicare billing and payment irregularities.
Must be able to support review findings by utilizing exceptional analytical, written and oral communication skills.
Ethical, self-motivated and results oriented team player.
Strong analytical, verbal and written communication skills.
Outstanding people skills and ability to effectively review findings /results with management.
Must be proficient with PC and related software programs.
Excellent organizational skills.
Must be a team player.
Limited travel may be required.

Remote but need to be local to 18702

RN required