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The CDI Specialist utilizes expertise and clinical documentation improvement practices as well as program-specific tools to ensure best practices and compliance with the mission/philosophy, standards, goals and core values of Optum Health.
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Certification, Training, and Website: As a Virtual Wellness & Spa Travel Specialist, you'll receive industry-leading certification and training to equip you with the skills needed to craft transformative travel experiences for clients.
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Will be responsible for processing insurance verification and referral/pre-certification/pre-authorization requests. Prior Authorization Specialist. Knowledge of registration, verification, pre-certification, and scheduling procedures.
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Certified high school diploma or GED Certifications in any of the following or similar: Anti-Money Laundering Specialist Certification (CAMS), Transaction Monitoring Associate (CTMA) Certification, Fraud Examiner (CFE) Certification, Financial Crimes Specialists (CFCS) Certification.
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Institutional (Facility) Coding Certifications: ONE of the following recognized institutional coding certifications: Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Outpatient Coder (COC), or Certified Coding Specialist (CCS.
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The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews and will perform appeal reviews as needed. Utilization Review Specialist/Behavioral Health Substance Abuse.
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Clinical Documentation Specialist - Second Level Reviewer - Remote page is loaded. Clinical Documentation Specialist - Second Level Reviewer - Remote. Current RN or MD required; CCDS or CDIP certification required; Coding certification (CCS, CIC, or CPC) preferred.
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Personnel Security Specialist III - Remote. Have successfully completed formal training in suitability adjudications towards adjudicator certification in compliance with National Training Standards established by OPM.
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Health Information Management or Coding certification required within three months of hire: RHIA (Registered Health Information Administrator), RHIT (Registered Health Information Technician), CPC (Certified Professional Coder), CCS (Certified Coding Specialist), CCS-P (Certified Coding Specialist Physician), or CCA (Certified Coding Associate.
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CISA, CISSP, HCISPP, CCSP, CISM, CTPRP or similar certification. Proficient understanding of and experience with audit, regulatory requirements, and standards (SOC2, ISO, HITRUST), and other related standards and certification processes.
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As an Ambulatory CDI Specialist, you will bridge the gap between the providers and coders/billers to clarify at-risk documentation to ensure accurate claim submission. License or Certification: This position requires an applicable CDIS or HIM (coding) credentialing through ACDIS, AHIMA, and/or AAPC. Or, this position requires an LPN or RN licensure with three years of ICD-10 and/or CPT/HCPCS coding.
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Epic Willow, Beacon, and/or Clarity Certification. In collaboration with Pharmacy Services and Information Services, Pharmacy Informatics Specialist participates in the analysis, design, implementation, education, and support of computer application systems (i.e. Epic, PACMed, Carousels, Robot, Pyxis, etc.
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CRCST or CBSPD Certification and additional certification (i.e. instrument specialist, flexible endoscope, healthcare leader, manager, STERIS Assessment) required. The Supervisor, Sterile Processing will provide onsite support, training, Customer Service, and communication regarding the processing of surgical instruments and staff management to contracted facilities in compliance with STERIS Standard Work or QMS, the Department of Health, TJC, DNV, OSHA, CDC, AAMI and AORN standards, and facility goals and policies.
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Manage the process of NCQA certification for HEDIS measures, including data collection, submission, and validation. You will participate in measure certification processes, such as the NCQA certification process for HEDIS measures.
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Certification in Healthcare Quality (e.g., Certified Professional in Healthcare Quality - CPHQ). As a Metrics Specialist, you will be responsible for extracting, analyzing, and interpreting healthcare quality data from multiple sources to support our Value-Based Purchasing (VBP) state programs.
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