- City and County of San Francisco (San Francisco, CA)
- …and review their operations. The Audit Division is also responsible for reviewing claims for public financing to ensure that City funds are only distributed to ... Qualifications_ Professional certification as a Certified Public Accountant, Certified Internal Auditor , or Certified Fraud Examiner. A Master's degree in public… more
- City and County of San Francisco (San Francisco, CA)
- …and review their operations. The Audit Division is also responsible for reviewing claims for public financing to ensure that City funds are only distributed to ... Professional certification as a Certified Public Accountant, Certified Internal Auditor , or Certified Fraud Examiner.A Master's degree in public administration,… more
- LA Care Health Plan (Los Angeles, CA)
- Claims Quality Auditor II Job Category: Claims Department: Claims Data and Support Services Location: Los Angeles, CA, US, 90017 Position Type: Full ... and to support the safety net required to achieve that purpose. Job Summary The Claims Quality Auditor II works closely with the Claims Quality … more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Claims Quality Review Auditor is HYBRID position accountable for auditing various claims to ensure quality and accuracy to ... and procedures and regulatory guidelines. Makes recommendations to improve quality , workflow processes, policies and procedures. **ESSENTIAL FUNCTIONS OF THE… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Claims Auditor 75 Vanderbilt Ave, Staten...keep up to date with departmental changes in conducting quality reviews. + Ensure the consistent use of current ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … more
- Medical Mutual of Ohio (OH)
- …DRG,_** **_and/or_** **_hospital bill auditing experience._** **Responsibilities** **Clinical Auditor ** + **Audits outpatient, inpatient and professional claims ... with payment recovery staff.** + **Performs other duties as assigned.** **Sr Clinical Auditor ** + **Audits outpatient, inpatient and professional claims from a… more
- Fallon Health (Worcester, MA)
- …Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high- quality , coordinated care and is continually rated among the nation's top ... health plans for member experience, service, and clinical quality . We believe our individual differences, life experiences, knowledge, self-expression, and unique… more
- Elevance Health (Indianapolis, IN)
- …lens, to deliver member-centered, lasting pharmacy care. The **Pharmacy Internal Auditor ** is responsible for driving service quality excellence by ... **Pharmacy Internal Auditor ** **Location:** This position will work a hybrid...processes and processes related to enrollment and billing and claims processing, as well as customer service written and… more
- Elevance Health (Columbus, OH)
- …or 1-hour commute each way of a relevant Elevance Health location. The **Performance Quality Auditor lll** is responsible evaluating the quality of services ... Included are processes related to enrollment and billing and claims processing, as well as customer service written and...include, but are not limited to: + Evaluates the quality and accuracy of transactions and/or communications with providers,… more
- State of Georgia (Fulton County, GA)
- Investigative Auditor - Medicaid Fraud Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/52416/other-jobs-matching/location-only) Hot ... Attorney General Department of Law Medicaid Fraud - Investigative Auditor *To move forward in the recruiting process ALL...of Georgia by providing legal representation of the highest quality to the agencies, officers and employees of state… more
- Elevance Health (Indianapolis, IN)
- … AUDITOR ** is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines ... **DRG (DIAGNOSTIC RELATED GROUP) CODING AUDITOR ** **Location** : This position will work a...AA/AS or minimum of 5 years of experience in claims auditing, quality assurance, or recovery auditing.… more
- Hackensack Meridian Health (Hackensack, NJ)
- …ensuring coding accuracy, coding consistency and efficiency in filing of inpatient claims . Collaborates with the Clinical Documentation Quality Liaison to assist ... as a leader of positive change. The **Diagnosis Related Group (DRG) Auditor ** is responsible for auditing clinical documentation that supports code assignment for… more
- Crawford & Company (Fresno, CA)
- Excellence In Everything We Touch Position Summary + Looking for California State Auditor for our CA Workers Compensation Claims Division! + Candidate must have ... experience as CA Claims Adjuster/Examiner! + CA Designation is not a requirement!...+ Multiple Employee Discounts! Ensures that clients receive a quality work product by adhering to the established standards… more
- Tennessee Comptroller of the Treasury (Nashville, TN)
- Auditor : Financial/TennCare This role focuses on examining, analyzing, and reviewing records, financial statements, claims data, and cost reports for providers ... The Comptroller of the Treasury is recruiting for a full-time Auditor : Financial/TennCare position in the Division of State Audit's Tenncare/Medicaid Section.… more
- Elevance Health (Columbus, OH)
- …a HS diploma or equivalent and a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of ... **Diagnosis Related Group Clinical Validation Auditor ** **Location:** This position will work a hybrid...Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes… more
- Fallon Health (Worcester, MA)
- …Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high- quality , coordinated care and is continually rated among the nation's top ... health plans for member experience, service, and clinical quality . We believe our individual differences, life experiences, knowledge, self-expression, and unique… more
- Dignity Health (Phoenix, AZ)
- …**Responsibilities** Under the supervision of the Business Office Leadership, the Revenue Cycle Auditor role is responsible for monitoring the quality of work ... solid understanding of accounts receivable and your role as a Revenue Cycle Auditor : *Payor Rules & Regulations *Understanding contract language *CCI Coding Issues *… more
- Sedgwick (Knoxville, TN)
- …Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Internal Auditor - IT **PRIMARY PURPOSE:** To perform IT internal audit procedures under ... + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **Education & Licensing** Bachelor's degree… more
- Hackensack Meridian Health (Hackensack, NJ)
- …a leader of positive change. The **Ambulatory Payment Classification (APC) Auditor ** performs all related internal, concurrent, prospective and retrospective coding ... Hackensack Meridian Health (HMH) network. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to APC's, ICD… 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 ... and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million...+ Reviews information from third party payers relative to claims charging, coding, and billing in order to ensure… more
