Remote Clinical Trainer & Auditor - NCQA/CMS Expert
Blue Cross Blue Shield of Arizona
- Remote job
Blue Cross Blue Shield of Arizona is seeking a Clinical Trainer and Auditor to plan, develop, deliver, and evaluate diverse clinical education programs for health plan operations. The role supports NCQA, CMS, and AHCCCS requirements and collaborates with leadership to improve staff performance. The position requires a nursing background with relevant managed care and audit experience, and offers a full-time hybrid work arrangement with on-site and remote duties within Arizona. #J-18808-Ljbffr Blue Cross Blue Shield of Arizona
- ...as hybrid, onsite or remote. While the majority of... ...OF THE JOB The Clinical Trainer and Auditor is responsible for planning... ...to that required for NCQA accreditation, New... ...of Care Training, and CMS and AHCCCS requirements... ...as subject matter expert on policies and procedures...Remote jobCmsFull timeWork experience placement1 day per week
- ...positions are classified as hybrid, onsite or remote. While the majority of our employees are... ...designing, delivering, and evaluating clinical training programs and audit activities... ...applicable state, federal, AZ Blue, URAC, CMS and other regulatory and accreditation standards...Remote jobCmsFull timeWork experience placement1 day per week
- A consulting organization in health care is seeking Board Certified Urologists for a short-term engagement as Clinical Expert Consultants. This remote position involves participating in virtual interviews to provide insights on treatment options related to neurogenic conditions...Remote jobCmsTemporary workFlexible hours
$92.4k - $133.67k
...accordance with CMS and DHCS and... ...4 Assists the clinical team in responding... ...subject matter expert by representing... ...policy regarding NCQA, DHCS, CMS and/... ...and Compliance Auditors on regulatory... ...required. DHCS Master Trainer required.... ...: Partially Remote An annual employee...Remote workCmsContract workFor contractorsLocal areaHome office- SCAN Health Plan is seeking a Compliance Auditor to lead regulatory reviews and audits, ensuring adherence to CMS, DHCS, and NCQA standards. You will train providers and SCAN staff, interpret complex regulations, and drive improvement actions across teams. The role emphasizes...Remote jobCms
- UnitedHealth Group is seeking a Clinical DRG RN auditor to apply expert MS-DRG/APR-DRG coding knowledge and ICD-... ...guidelines in inpatient claims audits. This remote role allows telecommuting from... ..., and drafting rationales using CMS requirements and AHA guidance. A RN...Remote jobCmsRelocation package
- Providence Home Services Oregon is seeking a Clinical Documentation Specialist RN to... ...OASIS and Plan of Care reviews for CMS compliance, working remotely with day shifts and weekdays. The... ...Health leadership and acts as Oasis expert and consultant across the region. The...Remote jobCmsDay shiftWeekday work
Clinical Documentation Specialist RN to ensure CMS program compliance through meticulous review of OASIS admission... ...and Plans of Care. This full-time, day shift role is remote for eligible states and collaborates with Home Health...
Remote jobCmsFull timeDay shift- ...our team. Job Summary The Clinical Documentation Improvement (CDI) Auditor Educator will facilitate improvement... ...MEMORIAL HERMANN CANNOT HIRE REMOTE WORKERS IN THE FOLLOWING STATES:... ...Approved AHIMA ICD-10-CM/PCS Trainer preferred Previous CDIS auditing...Remote workCmsTemporary workFlexible hours
- Providence Health and Services is seeking a Clinical Documentation Specialist, RN for the... ...admission documents and Plans of Care to ensure CMS compliance and optimal patient outcomes.... ...Health leadership, acting as an Oasis expert and consultant to staff across the region...Remote jobCms
$72.8k - $129.9k
...some tough challenges.Primary Responsibilities:Responsible for clinical quality audits Gathering and reporting data Coordinating and facilitating... ...experience in any healthcare settingExperience interacting with NCQA of JCAHO reviewersExperience writing program evaluations and...Remote workWork experience placementWork at officeLocal area$35 - $62.5 per hour
...Clinical DRG RN Auditor $10,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS Optum... ...auditor, you will apply your expert knowledge of the MS-DRG and... ...disposition, in accordance with CMS requirements, ICD-10... ...to work independently in a remote environment and deliver exceptional...Remote jobCmsHourly payDaily paidMinimum wageFull timeTemporary workPart timeWork experience placementWork at officeLocal areaRelocation package- ...within the UM program. The focus is on CMS/NCQA compliance, data analysis, and risk trends... ...for workflows. The role requires deep clinical criteria expertise, regulatory knowledge... ...findings into actionable improvements. Remote work and travel for training may be required...Remote jobCms
$70.14k - $107.25k
...Description The Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG... ...Proficient understanding of Medicare, CMS guidelines and ICD-10 coding guidelines... ..., drug free workplace, and complies with ADA regulations as applicable. #LI-Remote...Remote workCmsMinimum wageFull timeWork at officeLocal areaFlexible hours$150 per hour
...Compensation: $150/hour Location: Remote Role Responsibilities Manage end-to... ...authorisation workflows for medical and clinical services across multiple payer types.... ...peer review processes. Familiarity with CMS prior authorisation rules and the No Surprises...Remote workCmsContract workSummer workWork at office- ...is seeking a Risk Adjustment Coding Auditor to ensure accuracy of coded clinical data across risk adjustment... ..., based out of Eagan, MN but fully remote, requires CRC certification and 3+... ...adjustment records.You will review CMS HCC categories, ensure compliance,...Remote workCmsContract work
- ...Job Title: Clinical Training Specialist Lead Overview: The Clinical Training Specialist Lead role... ...patient engagement, virtual care delivery, and use of remote monitoring tools and platforms. Stay up to date with CMS guidelines and payer-specific policies impacting...Remote workCmsFull timePart timeMonday to FridayShift work
- Universal Health Services (UHS) is seeking a Coder Auditor to ensure ICD-10, CPT-4, and HCPCS coding is supported by clinical documentation and meets CMS requirements. The role emphasizes accuracy, productivity, and continual education for providers on documentation standards...Cms
$32 - $37 per hour
...Description* The Risk Adjustment Coding Auditor ensures the accuracy and completeness of coded clinical data to support compliant... ...diagnosis code capture based on CMS HCC categories Maintains... ...*Workplace Type*This is a fully remote position. *Application Deadline*...Remote workCmsContract workTemporary work- Medical Mutual is seeking a Quality Improvement RN to ensure NCQA, HEDIS and CMS compliance through chart reviews and data analysis. You will... ...requires Ohio-licensed registered nurses with 3 years of clinical experience, preferably in a health plan. A BSN is preferred...Remote jobCms
$23.87 per hour
...Coding Auditor - Professional Department: Physician coding Hours: Full-Time (40 hours per week) Location: Remote or onsite. Must reside in one of the following states: Alabama, Arkansas... ...ensure appropriate documentation for clinic services. Report results to Coding Supervisor...Remote workCmsFull time- ...Clinical Quality Reviewer TapestryHealth is dedicated to improving the quality of care for patients in skilled nursing facilities... ...inform governance decisions and keep TapestryHealth aligned with CMS, NCQA, HEDIS, and HIPAA/OIG standards. Key Responsibilities...Remote workCms
- ...Clinical Measures Nurses The Location: Falls Church, VA Falls... ...world, with military and civilian experts supporting military health... ...measurement (HEDIS, NPIC, NSQIP,TQIP NCQA, Hospital Compare, Leapfrog)... ..., VA with a possibility of remote. KurzSolutions is committed...Remote workCmsContract work
$23.87 per hour
...Coding Auditor - Professional page is loaded## Coding Auditor - Professionalremote type:... ...experience, starting at $23.87/hourLocation: Remote or onsite: At this time, you must reside... ...to ensure appropriate documentation for clinic services. Reports results to Coding Supervisor...Remote workCmsFull timeWork experience placement- ...accurate coding of outpatient hospital services and timely claim submission. You will apply ICD-10-CM, CPT, and HCPCS codes based on clinical documentation in line with payer and university guidelines. The role emphasizes coding quality, compliance, and productivity to...Remote jobCms
- ...seeking a Full-Time Coding Auditor. This role requires normal... ...Monday-Friday and is a remote position with occasional on... ...Acts as a Subject Matter Expert in coding and documentation... ...coding guidelines, AHA Coding Clinic Guidance, and CMS Risk Adjustment guidance....Remote workCmsFull timeWork at officeWork from homeMonday to Friday
$70k - $80k
...Outpatient Coding Auditor It takes great medical minds to create powerful solutions that... ...to official coding guidelines, coding clinics and regulatory guidelines and mandates.... ...What You Should Expect In This Role: Remote (work from home) environment within the United...Remote workCmsFull timeContract workWork from homeFlexible hours- ...Specialist II to review provider documentation and assign ICD and CPT codes. You will research denials, support clinical teams, and ensure coding accuracy in a remote-capable, full-time role. Qualifications include an active coding certification (CPC/CCS-P/CCS/CCM/RHIA/RHIT...Remote jobCmsFull time
$116.72k - $175k
DescriptionClinical Revenue Auditor-CDM Patient Financial Services-Corporate-Full-Time-Days- Hybrid.The Clinical Revenue Auditor for the Mount Sinai Health System (MSHS) and the... ...Centers for Medicare and Medicaid Services (CMS).Mitigate the risk of compliance violations,...CmsFull timeTraineeshipLocal area- ...APR-DRG assignment and documentation alignment. Collaborate with Clinical Documentation Specialists to resolve documentation gaps,... ..., and help reduce denials. AHIMA/APAC certs and 1 year experience required; remote work options available. #J-18808-Ljbffr UI HealthRemote jobCms
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