- MultiPlan (Atlanta, GA)
- …will employ data mining and coordination of benefit techniques to analyze and audit hospital and physician claims to identify errant claim payments. JOB ... and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness...to shine! JOB SUMMARY: This role reviews medical paid claims against provider contracts and policies to ensure medical… more
- MultiPlan (Atlanta, GA)
- …will employ data mining and coordination of benefit techniques to analyze and audit hospital and physician claims to identify errant claim payments. The ... and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness...to shine! JOB SUMMARY: This role reviews medical paid claims against provider contracts and policies to ensure medical… more
- Option Care Health (Chicago, IL)
- …advanced analytics techniques to analyze large datasets, such as related to healthcare operations, billing, claims , and patient information to support Compliance ... experience will be considered. Minimum of 5-7 years of experience in healthcare compliance, audit , analytics or related field, with at least 2-3 years in a… more
- Northeast Georgia Health System, Inc (Oakwood, GA)
- …with other documentation, coding and billing standards. CEQAs apply standardized audit scoring methodology to evaluate consistency of documentation and coding, and ... standardized audit findings methodology to report audit results....CCS-P Coding Certification. CPMA, CEMC or other Nationally recognized healthcare auditing certification required at hire, or required to… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …any related items. This person may work with managed care payors to resolve claims and related issues in order to enhance managed care contract performance. Supports ... polices, and regulations. Demonstrates a knowledge of the changes in the healthcare industry and federal regulations to ensure the contracts applications reflect the… more
- Valmont Industries, Inc. (Claremore, OK)
- …being followed and documentedUtilize legal counsel to respond to agency audit request, complaint investigation/resolution measures, unemployment claims & appeals ... upon the role, work schedule, or location and can include the following: Healthcare (medical, prescription drugs, dental and vision)401k retirement plan with company… more
- LogixHealth (Bedford, MA)
- Location: On-Site in Bedford, MA This Role: As a Claims Specialist, you will work with internal teams to provide cutting-edge solutions that will directly improve ... the healthcare industry. You'll contribute to our fast-paced, collaborative environment...and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,… more
- LogixHealth (Bedford, MA)
- …teams to provide cutting edge solutions that will directly improve the healthcare industry. You'll contribute to our fast-paced, collaborative environment and bring ... issues and appeal if necessary, using software or other resource tools + Prepare audit results and keep department manager current of all findings and audits and… more
- Robert Half Accountemps (Sterling Heights, MI)
- …in a dynamic environment, handling a variety of responsibilities related to healthcare billing and claims . Responsibilities: * Facilitate reconciliation of ... Microsoft Excel for efficient data management * Work independently, demonstrating proficiency in healthcare billing and claims in the healthcare industry.… more
- Axis (Princeton, NJ)
- …selection process. **Job Description** AXIS is seeking a **Head of A&H** **Reinsurance** ** Claims ** to join our Global Reinsurance Claims team reporting to the ... Global Head of Reinsurance Claims . As the Head of...service and accurate reinsurance reporting. Develop and execute on post- audit Management Action Plans (MAP) as needed. + Lead… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Claims Auditor 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #1153 Monday, July 1, 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
- Marshfield Clinic (Marshfield, WI)
- …support the most exciting missions in the world!** **Job Title:** SHP Claims Auditor (remote) **Cost Center:** 682891379 SHP- Claims **Scheduled Weekly Hours:** ... (United States of America) **Job Description:** **JOB SUMMARY** The SHP Claims Auditor is responsible for performing payment, procedural accuracy, turnaround time,… more
- AmeriHealth Caritas (Manchester, NH)
- **Provider Network Operations Claims Analyst Sr (hybrid)** Location: Manchester, NH Primary Job Function: Provider Network ID**: 34151 **Job Brief** The Provider ... Operations department. This role is responsible for: + UAT/Client Review & audit (fee schedule concentration) - reviews requests prior to initial submission to… more
- UNC Health Care (Rocky Mount, NC)
- …health and well-being of the unique communities we serve. **Summary:** The Recovery Audit Nurse will work closely with other Business Office staff members to assist ... in facilitating: 1) clinically related reviews of patient accounts/ claims to ensure compliant billing guidelines (internal and external) are followed (including, but… more
- Elevance Health (Denver, CO)
- …which would provide an equivalent background. **Preferred Qualifications:** + Pharmacy Claims Audit Strongly preferred + PBM (Pharmacy Benefit Management) ... **Position Overview:** Responsible for handling high level pharmaceutical claim audits and reviewing claims issues from junior team to ensure claims are being… more
- CVS Health (Olympia, WA)
- …Utilize recruitment databases and contract management tools to design, build, load, audit , and edit complex contracts, agreements, amendments and fee schedules for ... Required Qualifications + 3-5 years of experience working in managed healthcare contracting, network management, or supporting roles. Preferred Qualifications +… more
- UCLA Health (Los Angeles, CA)
- …an award-winning health system. Help improve patient experiences as part of a world-class healthcare team. Take your career in an exciting new direction. You can do ... requirements. You will manage the coding consultants who provide audit , coding expertise, and provider education to internal and...of HCC models V24 and V28 + Familiarity with claims and encounter data processes + Experience conducting mock… more
- Molina Healthcare (Covington, KY)
- …be working in the core PST timezone. Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization ... analyzing financial/performance management metrics + Must have experience in Healthcare environment specifically Claims **Preferred Education** Bachelor's Degree… more
- Molina Healthcare (Georgetown, KY)
- …standard EST business hours **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network ... utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on… more
- HCA Healthcare (Campbell, CA)
- …with claim management on performance management recommendation. . Weekly review of high-dollar claims . . Review and analyze audit data, including trend results ... the range. **Introduction** Are you passionate about the patient experience? At HCA Healthcare , we are committed to caring for patients with purpose and integrity.… more
