- SSM Health (St. Louis, MO)
- …calling** MO-SSM Health Mission Hill **Worker Type:** Regular **Job Highlights:** RN-Clinical Auditor Manager , Care Transformation - Case Management and Social ... by splitting charges that should be presented on separate claims to capture entitled revenue. + Improves claim... claims to capture entitled revenue. + Improves claim submissions by reviewing, researching, resolving, and trending … more
- Fallon Health (Worcester, MA)
- …recommendations and management action plans by working under the direction of the Lead Auditor or Audit Manager . + Prepare detailed work papers for each project ... all aspects of audits following departmental standards and procedures. **The Internal Auditor will perform or assist in the following:** + Supports the internal… more
- LA Care Health Plan (Los Angeles, CA)
- …Job Summary The Claims Quality Auditor II works closely with the Claims Quality Auditing Manager . The Claims Quality Auditor II maintains ... regulations and company policies. Responsible for High Dollar Claim review of 125K, current knowledge of First Pass...Plan environment. At least 3 years experience as a claims auditor /analyst. Prior experience working with Provider… more
- Commonwealth of Pennsylvania (PA)
- …(CFE) + Certified Government Audit Professional (CGAP) + Certified Government Financial Manager (CGFM) + Certified Internal Auditor (CIA) + Certified Information ... (CFE) + Certified Government Audit Professional (CGAP) + Certified Government Financial Manager (CGFM) + Certified Internal Auditor (CIA) + Certified Information… more
- Medical Mutual of Ohio (OH)
- …DRG,_** **_and/or_** **_hospital bill auditing experience._** **Responsibilities** **Clinical Auditor ** + **Audits outpatient, inpatient and professional claims ... staff.** + **Performs other duties as assigned.** **Sr Clinical Auditor ** + **Audits outpatient, inpatient and professional claims...claims can be processed. Works with lead or manager to implement changes.** + **Orients, trains, assists and… more
- Elevance Health (Indianapolis, IN)
- …claim identification, and documentation purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside of the concept ... **DRG (DIAGNOSTIC RELATED GROUP) CODING AUDITOR ** **Location** : This position will work a...auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all… more
- Henry Ford Health System (Troy, MI)
- …to the Manager , Revenue Integrity, the Revenue Integrity (RI) Auditor must have a comprehensive understanding of medical terminology, coding, charge entry, ... and revenue cycle processes. The RI Auditor provides support for timely, accurate and inclusive charge...professional), related medical terminology, use of medical records, billing claim forms, and federal and state regulations related to… more
- Elevance Health (Indianapolis, IN)
- **Pharmacy Internal Auditor ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our ... lens, to deliver member-centered, lasting pharmacy care. The **Pharmacy Internal Auditor ** is responsible for driving service quality excellence by evaluating the… more
- Quality Technology Services, LLC (Atlanta, GA)
- …Audit Senior** " will work with the Chief Audit Executive and Audit Senior Manager to continue building on the value driven audit approach we have established, with ... closely with QTS Executive and Operations leadership. The Senior Auditor is based at QTS's headquarter in Overland Park,...participate in the investigation of any complaint or discrimination claim . The "Know Your Rights" Poster is included here:… more
- Hackensack Meridian Health (Hackensack, NJ)
- …as a leader of positive change. The **Diagnosis Related Group (DRG) Auditor ** is responsible for auditing clinical documentation that supports code assignment for ... includes compliance with the Conditions of Participation for CMS. The DRG auditor is responsible for ensuring coding accuracy, coding consistency and efficiency in… more
- Elevance Health (Columbus, OH)
- **Diagnosis Related Group Clinical Validation Auditor ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within ... one of our PulsePoint locations. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to ensure clinical… more
- Elevance Health (Columbus, OH)
- **Clinical Provider Auditor II** **Supports the Payment Integrity line of business** _Location: This position will work a hybrid model (remote and office). The ideal ... recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Provider Auditor II** is responsible for identifying issues and/or entities that… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Inpatient Auditor and Educator Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the region's top-performing ... initiative and independent judgment. Reports to the Corporate Coding Manager . Recruiter: Kathleen Rice || ###@covhlth.com || ###...+ Reviews information from third party payers relative to claims charging, coding, and billing in order to ensure… more
- Elevance Health (Columbus, OH)
- …each way of a relevant Elevance Health location. The **Performance Quality Auditor lll** is responsible evaluating the quality of services and interactions provided ... Included are processes related to enrollment and billing and claims processing, as well as customer service written and...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- City and County of San Francisco (San Francisco, CA)
- …effective operations within the Commission. Auditors also play a key role in reviewing claims for public financing to ensure that City funds are only distributed to ... and in accordance with program requirements. This position reports to the Audit Manager and is responsible for leading audits and other projects. As with all… more
- St. Luke's University Health Network (Allentown, PA)
- …The appeals process may include collaboration with the Claim Editing Manager , Physician, Specialty Coder, AR specialist or Auditor /Educator. Demonstrate the ... a patient's ability to pay for health care. The Claim and Denial Coding Analyst role is a Certified...role is a Certified Medical Coder who ensures clean claim submission and timely review and resolution of coding… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Claims Job Category: Claims Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11625 ... net required to achieve that purpose. Job Summary The Manager , Claims directs the efforts of others...and trend the metrics associated with the examiner and auditor production and prepare and present written and verbal… more
- AIG (Jersey City, NJ)
- …way we help customers to manage risk. Join us as an IT Risk and Controls Manager to play your part in that transformation. It's an opportunity to grow your skills ... is at the heart of everything we do, from underwriting risks to processing claims . The Information Technology team equips our colleagues with the latest tools to… more
- Nabors (Magnolia, TX)
- …is rapidly expanding. **JOB SUMMARY** As a manufacturing Quality Assurance/Quality Control Manager , you will be the focal point for all QA/QC functional and ... to define and implement corrective actions and preventive actions. The Quality Manager is ultimately responsible for ensuring consistent quality in both Systems and… more
- City of Somerville (Somerville, MA)
- Statement of Duties: The Benefits Manager is responsible for overseeing the enrollment of employees in the City's health and welfare benefits programs and ensuring ... compensation plans with assistance from third-party administrators. The Benefits Manager is a supervisory position, ensuring compliance with applicable local,… more