- HCA Healthcare (Nashville, TN)
- … like you to be a part of our team. **Job Summary and Qualifications** The Claims Auditor will serve as a Subject Matter Expert (SME) in medical claims ... an organization that invests in you as a **Claim Auditor ** ? At Work from Home, you come first. HCA Healthcare has committed up to $300 million in programs to… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Claims Auditor 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #1153 Tuesday, November 5, 2024 Centers Plan for Healthy Living's goal is to create the ... ultimate healthcare experience that provides our members, their families, ...auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- Summary With direction from the Patient Financial Services Director, the Nurse Auditor / Revenue Integrity/ CDM Analyst is responsible for performing audits of ... record and other applicable hospital documentation, assigning modifiers to appropriate claims , researching edited claims for medical necessity, and advising… more
- Fallon Health (Worcester, MA)
- …all aspects of audits following departmental standards and procedures. **The Internal Auditor will perform or assist in the following:** + Supports the internal ... (MAR - internal controls), financial and operational internal audits, claims testing for payment and financial accuracy, and other...plans by working under the direction of the Lead Auditor or Audit Manager. + Prepare detailed work papers… more
- Henry Ford Health System (Troy, MI)
- …and healthcare revenue cycle processes. The Revenue Integrity (RI) Auditor provides support for timely, accurate and inclusive charge capture, coding, billing ... Reporting to the Manager, Revenue Integrity, the Revenue Integrity Auditor must have a comprehensive understanding of medical terminology, coding, charge entry,… more
- Hackensack Meridian Health (Hackensack, NJ)
- …community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change. The **Diagnosis Related Group ... (DRG) Auditor ** is responsible for auditing clinical documentation that supports...accuracy, coding consistency and efficiency in filing of inpatient claims . Collaborates with the Clinical Documentation Quality Liaison to… more
- Elevance Health (Morristown, NJ)
- **Diagnosis Related Group Clinical Validation Auditor -RN** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live ... one of our PulsePoint locations. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to ensure clinical… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- Ready to help us transform healthcare ? Bring your true colors to blue. We What Need As a valued member of the Audit, Risk Management & Information Security (ARMIS) ... team, the Senior Internal Auditor will perform and support audits and assessments related...and risk-based audits of these areas (eg Enrollment, Premiums, Claims Operations, Provider Enrollment and Pricing, Accounting, and Information… more
- Idaho Division of Human Resources (Boise, ID)
- Medicaid Fraud Control Unit Investigative Auditor , OAG Posting Begin Date: 2024/10/17 Posting End Date: 2024/12/20 Category: Audit Sub Category: Program Management ... easy access. Primary Duties: The successful applicant for the the Investigative Auditor position will be assigned to the Attorney General's Medicaid Fraud Control… more
- Trinity Health (Albany, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Revenue Integrity Nurse Auditor - Remote - St. Peter's Hospital - FT Days** If you are looking ... of appropriately maximizing reimbursement based upon services delivered and ensuring claims are paid/settled in the most timely manner. + Coordinates concurrent… more
- Highmark Health (Columbus, OH)
- …Depending on location provides or arranges for education/training of facility healthcare professionals in use of coding guidelines and practices, proper ... Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA) + 5 years with hospital or physician...skills Preferred + Associate's Degree + 3 years with claims processing and data management + Past auditing and… more
- Health Advocates Network (Albany, NY)
- Health Advocates Network is currently seeking a ** Auditor ** to work at a facility in **Albany, New York.** These are _registry_ positions with our company. **Pay ... Friday / 8am - 4:30 pm **Duties:** + Answering telephone inquiries from healthcare providers, members caregivers and advocacy groups related to prior approval of… more
- Nuvance Health (Danbury, CT)
- …(SACO) Physician Audit & Billing, the Senior Inpatient Professional Auditor providesHospital Inpatient and Outpatient coding, billing, and documentation auditing ... and State guidelines. Ensure correct DRG and APC assignments for Institutional claims . 2. Maintains confidentiality of protected health information and other forms… more
- Covenant Health Inc. (Knoxville, TN)
- …to ensure compliance. + Reviews information from third party payers relative to claims charging, coding, and billing in order to ensure compliance. + Performs ... inpatient and out-patient and/or physician practice. Good working knowledge of healthcare billing, Medicare/Medicaid billing guidelines, and other Third Party Payor… more
- IQVIA (Bridgewater, NJ)
- …pharmacy audit requests. **Principal Accountabilities:** + Responsible for conducting pharmacy claims audits at the request of operations and management teams. May ... and review documentation necessary for assessing and validating compliance of claims against program business rules. + Exercise independent judgment to determine… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …Assists in the review of Bon Secours Mercy Health coding, billing and claims processing policies and procedures for the development of compliance internal monitors ... periodic review and analysis of Bon Secours Mercy Health hospital claims denial reports, operational assessment reports, internal quality control reviews, internal… more
- Novant Health (Wilmington, NC)
- …team member, we ensure a strong organization capable of providing remarkable healthcare to our patients, families and communities. Therefore, we invite applicants ... and levels of authority. Knowledge of insurance and handling of claims (including medical necessity and pre-existing conditions). Maintains and demonstrates… more
- Ascension Health (Kalamazoo, MI)
- …Advisor for additional specifics._ **Responsibilities** Perform periodic and ongoing audits of claims to ensure accuracy of coding and billing, and sufficiency of ... Team** Ascension Michigan operates 16 hospitals and more than 300 related healthcare facilities that together employ nearly 23,000 compassionate associates. When you… more
- Ascension Health (Indianapolis, IN)
- …Advisor for additional specifics._ **Responsibilities** Perform periodic and ongoing audits of claims to ensure accuracy of coding and billing, and sufficiency of ... Team** Ascension St. Vincent in Indiana has been providing rewarding careers in healthcare for over 148 years. With 24 hospitals throughout the greater Indianapolis… more
- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will ... be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and...+ Certified Inpatient Coder (CIC) + Certified Professional Medical Auditor (CPMA) **Desired Education (nice to have):** + Masters… more