- 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
- Molina Healthcare (NY)
- …Responsible for conducting various audits including, but not limited to; vendor, focal, audit the auditor. Confirm that documentation is clear and concise to ensure ... accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains to contracting (benefit and… more
- Guidehouse (Lewisville, TX)
- …is expected to perform all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims . Must work with other ... Billing Emphasis + Correcting and billing electronic and hardcopy claims + Submits Adjusted claims + Provides...or insurance information. + Works all rejection and payer audit reports within 48 hours of receipt taking whatever… more
- HCA Healthcare (Nashville, TN)
- …with claim management on performance management recommendation. + Weekly review of high-dollar claims . + Review and analyze audit data, including trend results ... ? At Work from Home, you come first. HCA Healthcare has committed up to $300 million in programs...part of our team. **Job Summary and Qualifications** The Claims Auditor will serve as a Subject Matter Expert… more
- Prime Healthcare (Ontario, CA)
- …improve the quality and minimize process cost of Claims for all Prime Healthcare 's self-insured Employee Health Plans. Through in-depth audit and review of ... is a rewarding #jobs. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/176331/vp-of-health-plan-operations-and- claims /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare Management Inc… more
- Molina Healthcare (UT)
- …Interfaces with the customer in developing requirements for major complex claims testing projects within Medicare, Medicaid and Marketplace; prepares system test ... ahead of their implementation. * Supports Integrated Test Facility (QA) as needed through audit and validation of testing wor completed. * Able to work in a project… more
- Scripps Health (San Diego, CA)
- …institutional claims . Candidate will manage successful Plan and DMHC Audit performance, staff education and training, and manages PDR process. This individual ... Health team and work alongside passionate caregivers and provide patient-centered healthcare . Receive endless appreciation while you build a rewarding career with… more
- Robert Half Accountemps (Plantation, FL)
- …billing, and claim administration, while utilizing various computer programs. Responsibilities: * Audit medical claims to ensure accuracy and compliance with ... We are offering a short term contract employment opportunity for a Medical Claims Analyst in the insurance industry, based in Plantation, Florida. As a Medical… more
- DoorDash (Tempe, AZ)
- …company's bottom line. The team is divided into three separate subgroups: Actuarial, Claims Operations, and Risk Management & Mitigation. We are looking for forward ... cross-functional partners at DoorDash. About the Role We are seeking an experienced claims specialist who will be a member of DoorDash's Corporate Risk & Insurance… more
- Elevance Health (Columbus, OH)
- **Staff VP Claims Operations (Original Claims )** **Location:** Successful candidate must reside within 50 miles of an Elevance office, and able to work a hybrid ... **Summary** Responsible for the strategic and operational business needs of original claims , or first-time claims , for the Government Business and Commercial… 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
- 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
- Carrington (Columbus, OH)
- **Come join our amazing team and work from home!** The Loss Mitigation FHA Claims Specialist will be responsible for preparing, filing, and following up on all FHA ... home retention claims timely and accurately according to investor/insurer guidelines. Perform...are imaged timely. + Maintain and controls the HUD audit file. + Perform other duties as assigned. **What… more
- New York State Civil Service (Albany, NY)
- …DASNY - Dormitory Authority of the State of New York Title Senior Construction Claims Analyst (Cost Control) - Albany, NY or NYC Office Occupational Category Other ... Control Analyst reviews and recommends approval of construction change orders, analyzes claims , and participates in the negotiation of claim settlements on complex… more
- The Cigna Group (Denver, CO)
- The Medical Claims FP&A Senior Manager will manage projection and results analysis for core Medicare Advantage Part C medical claims expense processed and paid ... to FP&A centralization, Market Finance, Product, Pricing, Reserving, Operations, and external Audit Firms. Given the close partnership between this team and the… more
- Fallon Health (Worcester, MA)
- …mitigate risk, and capture results. + 5-8 years of related health care claims auditing experience in a complex healthcare environment, with at least ... summary of purpose:** Under the general direction of the Senior Internal Audit Manager, theAnalyze and interpret patient medical records pertaining to FWA… more
- Centene Corporation (Austin, TX)
- …state of Texas to be considered for the position. **Responsibilities:** + The Claims Trainer II should understand basic claims billing requirements and ... programs + Maintain records of training activities and employee progress + Audit work and coordinate training initiatives to identify, develop and publish corrective… more
- UNC Health Care (Morrisville, NC)
- …we serve. **Summary:** The UNC Health Legal, Risk Management, and Audit Services Department seeks an energetic, skilled, resourceful, and business-savvy professional ... deploy technology tools and information to users of legal, risk management, and audit services. The Director of Operations will report directly to the Chief Legal… more
- Healthfirst (NY)
- …within any area of operations (Member Services, Enrollment & Billing, Claims , Provider Services, etc.). + Experience with database reporting and automation, ... budgeting or internal audit processes. + Experience monitoring quality in a reporting...accredited institution. **Preferred Qualifications:** + Experience working within a Healthcare industry (such as commercial insurance plans, hospital, managed… more
- UCLA Health (Los Angeles, CA)
- Description Contribute to the success of a world-class healthcare organization by ensuring compliance in regulatory audits and appeals. Leverage your expertise to ... UCLA Health's commitment to accuracy and quality in claim processing. As an Audit and Appeals Specialist, you will: + Facilitate responses to regulatory audits… more