- UCLA Health (Los Angeles, CA)
- …As the Medicare Advantage Risk Adjustment Provider Documentation Trainer and Auditor , you will be an expert in risk adjustment coding and documentation, working ... CPT and CPT (II), and HCPCS coding systems required + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical specifications, required + Knowledge of … more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Working under general ... experience, DRG,_** **_and/or_** **_hospital bill auditing experience._** **Responsibilities** **Clinical Auditor ** + **Audits outpatient, inpatient and professional claims from… more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... a key role in auditing risks identified in the organization. The Senior Internal Auditor plays a key role in implementing the annual audit plan. The Senior Internal… 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 Time Requisition ... the safety net required to achieve that purpose. Job Summary The Claims Quality Auditor II works closely with the Claims Quality Auditing Manager. The Claims Quality… 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 ... with the Conditions of Participation for CMS. The DRG auditor is responsible for ensuring coding accuracy, coding consistency...with all DRG mandates and reporting requirements. + Monitors Medicare and other DRG payment bulletins and manuals and… more
- Humana (Louisville, KY)
- …developing and maintaining relationships within a company? The role of the Internal Auditor 1 includes these and more! Humana's Internal Audit Consulting Group has a ... great opportunity for an exceptional Internal Auditor 1 to provide value-added service by evaluating the...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …is eligible for the Flex persona The Risk Adjustment Senior Coding Quality Auditor & Educator provides education and training for the Risk Adjustment Coding team ... of relevant training. The Risk Adjustment Senior Coding Quality Auditor & Educator will utilize analytics to identify and...training to include but not limited to ICD-10-CM and Medicare Risk Adjustment coding to new associates and existing… more
- Johns Hopkins University (Baltimore, MD)
- We are seeking a **Sr. Compliance Auditor ** **Trainer** who will provide on-going training and support to physicians, non-physician providers, professional fee ... + Keeps current with third party regulations with emphasis on Medicare billing, teaching physician regulations, Current Procedural Terminology, ICD-9-CM Coding, and… more
- Elevance Health (Columbus, OH)
- **Audit & Reimbursement Lead- Quality Auditor ** _Location: This is a United States based, virtual position._ **National Government Services** is a proud member of ... Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare... experience which includes previous experience at a Senior Auditor level in health care, public accounting or a… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** **Description:** **Job Title:** Coding Auditor and Educator (Remote) **Employment Type:** Full-Time **Shift:** Days ... DC and Baltimore, MD. **Description:** + Monday-Friday The Professional Coding Auditor Educator performs medical record audits including but not limited to… more
- Humana (Columbus, OH)
- …the achievement of Humana's strategic and financial objectives. The Internal Auditor 2 provides value-added service by evaluating the efficiency and effectiveness ... of Humana's operational processes. The Internal Auditor 2 executes audit plans and prepares reports for...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... of audits following departmental standards and procedures. **The Internal Auditor will perform or assist in the following:** +...plans by working under the direction of the Lead Auditor or Audit Manager. + Prepare detailed work papers… more
- CHS (Clearwater, FL)
- **Overview** ** ** **Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary:** The Claims & Call Auditor audits processed medical insurance ... + Knowledge of medical coding systems + Knowledge of Medicaid/ Medicare Guidelines + Knowledge of billing rules and regulations....to thirty (30) pounds. ** ** **Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** **… 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 ... Office of the Attorney General Department of Law Medicaid Fraud - Investigative Auditor *To move forward in the recruiting process ALL applicants are required to:… more
- State of Maine, Bureau of Human Resources (Augusta, ME)
- Staff Auditor I Augusta , Maine , United States | Auditor | Full-time | Partially remote Apply by: Sept. 30, 2024 Apply with Linkedin Apply Department of Health ... to its staff. ABOUT THE POSITION: As a Staff Auditor I you will: + Perform professional audit work...grow personally and professionally as you acquire knowledge of Medicare , Medicaid, and Federal grants. REQUIREMENTS: To qualify, you… more
- Hackensack Meridian Health (Hackensack, NJ)
- …and serve as a leader of positive change. The **Coding Quality Auditor ** is responsible for monitoring compliance with applicable clinical documentation to support ... **Responsibilities** A day in the life of an **Coding Quality Auditor ** at **Hackensack Meridian** **_Health_** includes: + Reviews Diagnosis Related Group… 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 East Tennessee's top-performing ... and analysis of ICD-10 and ICD-10-PCS coding to ensure compliance with Medicare , Medicaid guidelines and other insurance payers and to optimize reimbursement .… more
- Nuvance Health (Danbury, CT)
- …(SACO) Physician Audit & Billing, the Senior Inpatient Professional Auditor providesHospital Inpatient and Outpatient coding, billing, and documentation auditing ... rules and regulations consistent with Nuvance Health policies, ie, Center for Medicare & Medicaid Services (CMS), American Medical Association (AMA), American Health… more
- State of Colorado (Denver, CO)
- SNAPQA Auditor Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4663795) Apply SNAPQA Auditor Salary $57,708.00 - $92,340.00 Annually ... name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure… more
- TEKsystems (Norfolk, VA)
- As the Medical Coding Auditor If you're ready to explore the next step in your career: You'll enjoy Career Opportunities - Tons of growth opportunities for you ... of reports to accomplish tasks, such as AMA guidelines, Medicare LCD's, commercial payor billing guidelines, coding manuals and...and Strengths: Medical Coding | ICD-10 Codes | Coding Auditor | Audits | CPC | Insurance Payer Knowledge… more