- Martin's Point Health Care (Portland, ME)
- …Position Summary Job Description Position Summary: Under the supervision of the Director of Health Plan Operations, the Claims Auditor II will perform the ... Join Martin's Point Health Care - an innovative, not-for-profit health...relevant experience. + 5 or more years of related medical claims auditing experience or equivalent experience.… more
- HCA Healthcare (Nashville, TN)
- …The Claims Auditor will serve as a Subject Matter Expert (SME) in medical claims processing at health plan payor, MSO, HMO, and IPA organizations ... an organization that invests in you as a **Claim Auditor ** ? At Work from Home, you come first....environment, required + Hands-on knowledge and functional understanding of medical claims billing, processing, terminology, diagnosis and… more
- Medical Mutual of Ohio (OH)
- …of clinicaland medical auditing experience. **Professional Certification(s)** + Certified Medical Auditor (if not certified required to obtain within 18 ... DRG,_** **_and/or_** **_hospital bill auditing experience._** **Responsibilities** **Medicare Clinical Auditor ** + **Audits outpatient, inpatient and professional claims… more
- Elevance Health (MD)
- **Clinical Provider Auditor I** **Supports Payment Integrity & Behavioral Health ** _Location: This position will work a hybrid model (remote and office). The ... medical -expense spending. A proud member of the Elevance Health family of companies, Carelon Behavioral Health ,...prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- … record and other applicable hospital documentation, assigning modifiers to appropriate claims , researching edited claims for medical necessity, and ... inpatient hospitalizations, diagnostic testing, outpatient procedures and services, home health care services, durable medical equipment, rehabilitative… more
- UPMC (Pittsburgh, PA)
- …in collaboration with appropriate Health Plan departments including Quality Improvement, Claims , and Medical Directors as needed to facilitate the resolution ... UPMC Health Plan is looking for an Intermediate Clinical Auditor /Analyst to join the Quality Assurance team! This role will work standard daylight hours, Monday… more
- Catholic Health Initiatives (Chattanooga, TN)
- …Coders (AAPC) as a Certified Professional Coder (CPC) required. Professional Medical Auditor Certification (CPMA) (CMAS)-preferred but not required. CRC ... **Overview** **CHI Memorial Mountain Management** CHI Memorial Medical Group (Mountain Management Services), now part of... Group (Mountain Management Services), now part of CommonSpirit Health formed between Catholic Health Initiatives (CHI)… more
- Iowa Department of Administrative Services (Des Moines, IA)
- …benefits. Health and Wellness: Prioritize your well-being with our comprehensive health plans, including medical , dental, and vision coverage. Enjoy the ... Accounting Tech 3 - Pre- Auditor Print (https://www.governmentjobs.com/careers/iowa/jobs/newprint/4725512) Apply Accounting Tech 3 - Pre- Auditor Salary… more
- Henry Ford Health System (Troy, MI)
- Reporting to the Manager, Revenue Integrity, the Revenue Integrity Auditor must have a comprehensive understanding of medical terminology, coding, charge entry, ... and healthcare revenue cycle processes. The Revenue Integrity (RI) Auditor provides support for timely, accurate and inclusive charge...medical centers and is leading the Future of Health : Detroit, a $3 billion investment anchored by a… more
- Elevance Health (Morristown, NJ)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... our PulsePoint locations. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical ...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… 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
- Rising Medical Solutions (Chicago, IL)
- …With offices, providers, and case managers nationwide, RISING provides comprehensive medical claims solutions to our valued clients: insurance carriers, ... business was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor...within! + Opportunity to make a difference in reducing health care costs and increasing the value of … more
- General Motors (Columbus, OH)
- …of health and wellbeing benefit programs. Benefit options include medical , dental, vision, Health Savings Account, Flexible Spending Accounts, retirement ... worksite unless directed by their manager. **The Role** The individual Dealer Auditor reviews the administration of General Motors policies and procedures as… more
- Humana (Columbus, OH)
- …nurse will apply clinical and coding experience to conduct reviews of medical claims . Understands department, segment, and organizational strategy and operating ... part of our caring community and help us put health first** The Nurse Auditor 2 performs... 2 performs clinical audit/validation processes to ensure that medical record documentation for services rendered is complete, compliant… more
- Elevance Health (San Juan, PR)
- …delivery organization, providing information technology and business operations services for health plans._ **Performance Quality Auditor I** **Location:** This ... _A proud member of the Elevance Health family of companies, Carelon Global Solutions, formerly...that the unit will be supporting. The **Performance Quality Auditor I** is responsible for evaluating the quality of… 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
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …the Audit, Risk Management & Information Security (ARMIS) team, the Senior Internal Auditor will perform and support audits and assessments related to financial and ... to Sarbanes-Oxley), risk-based audits, and consulting engagements. The Senior Internal Auditor will participate in cross-functional projects with IT Audit, Risk… more
- Dignity Health (Rancho Cordova, CA)
- **Overview** Dignity Health Medical Foundation established in 1993 is a California nonprofit public benefit corporation with care centers throughout California. ... Dignity Health Medical Foundation is an affiliate of...supervision of the Business Office Leadership the Business Office Auditor role is responsible for monitoring the quality of… more
- Sedgwick (Knoxville, TN)
- …regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than ... 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… more
- Nuvance Health (Danbury, CT)
- …and State guidelines. Ensure correct DRG and APC assignments for Institutional claims . 2. Maintains confidentiality of protected health information and other ... policies, ie, Center for Medicare & Medicaid Services (CMS), American Medical Association (AMA), American Health Information Management Association (AHIMA), to… more