- 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 related ... help adherence to regulatory guidelines, internal policies and procedures related to claims processing and departmental accuracy standards related to claims … more
- LA Care Health Plan (Los Angeles, CA)
- …in a Health Plan environment. At least 3 years experience as a claims auditor /analyst. Prior experience working with Provider Dispute Resolution (PDR) , ... Claims Quality Auditor II Job Category:...maintains up-to-date knowledge of current trends and issues in healthcare , national and statewide standards and regulations, policies and… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Claims Auditor 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #1153 Monday, September 9, 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
- Fallon Health (Worcester, MA)
- …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 ... Auditor conducts audits and related projects (financial, operational, and...as special requests. This could include the completion of claims , operational, financial and compliance audits, as well as,… more
- New York State Civil Service (Syracuse, NY)
- NY HELP No Agency Attorney General, Office of the Title Forensic Auditor : Support Healthcare Fraud Investigations (6342) Occupational Category Financial, ... statistical sampling and/or advanced statistical training.* Knowledge of the healthcare industry and medical coding concepts (CPT, ICD-9 /...ICD-9 / 10, DRGs) and/or experience analyzing health care claims data.* A CPA is not required; but the… more
- Fallon Health (Worcester, MA)
- …all aspects of audits following departmental standards and procedures. **The Internal Auditor will perform or assist in the following:** + Supports the internal ... (MAR - internal controls), financial and operational internal audits, claims testing for payment and financial accuracy, and other...plans by working under the direction of the Lead Auditor or Audit Manager. + Prepare detailed work papers… more
- Molina Healthcare (Los Angeles, CA)
- …will work remotely anywhere in the US.** **Job Summary** The Sr Auditor , Delegation Oversight will independently perform audits of multi-delegated functions with ... and State Medicaid entities. **Job Duties** + Oversees Utilization Management, Claims , Organizational Credentialing, and Crisis Call Center delegated activities. +… more
- Elevance Health (Indianapolis, IN)
- …billing, claims and/or customer contact automated environment (preferably in healthcare or insurance sector), including a minimum of 1-year related experience in ... **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 (Indianapolis, IN)
- **DRG (DIAGNOSTIC RELATED GROUP) CODING AUDITOR ** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live within 50 ... our Elevance Health PulsePoint locations. The **DIAGNOSTIC RELATED GROUP CODING AUDITOR ** is responsible for auditing inpatient medical records and generating high… more
- Hackensack Meridian Health (Hackensack, NJ)
- …community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change. The **Diagnosis Related Group ... (DRG) Auditor ** is responsible for auditing clinical documentation that supports...accuracy, coding consistency and efficiency in filing of inpatient claims . Collaborates with the Clinical Documentation Quality Liaison to… more
- Elevance Health (Columbus, OH)
- **Diagnosis Related Group Clinical Validation Auditor ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within ... one of our PulsePoint locations. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to ensure clinical… more
- Elevance Health (Columbus, OH)
- …systems/tools to accurately document determinations and continue to next step in the claims lifecycle. + Researches new healthcare related questions as necessary ... **Clinical Provider Auditor II** **Supports the Payment Integrity line of...abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines… more
- Dignity Health (Phoenix, AZ)
- …research and leadership roles.DHMG is also heavily involved in preparing tomorrows healthcare providers. DHMG has 84 medical school students and approximately 200 ... supervision of the Business Office Leadership, the Revenue Cycle Auditor role is responsible for monitoring the quality of...receive up to $9,000. While you're busy impacting the healthcare industry, we'll take care of you with benefits… more
- Hackensack Meridian Health (Hackensack, NJ)
- …community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change. The **Ambulatory Payment ... Classification (APC) Auditor ** performs all related internal, concurrent, prospective and retrospective coding audit activities across the Hackensack Meridian Health… 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 ... healthcare network with 10 hospitals (http://www.covenanthealth.com/hospitals/) , outpatient and...+ Reviews information from third party payers relative to claims charging, coding, and billing in order to ensure… more
- Elevance Health (Columbus, OH)
- …each way of a relevant Elevance Health location. The **Performance Quality Auditor lll** is responsible evaluating the quality of services and interactions provided ... Included are processes related to enrollment and billing and claims processing, as well as customer service written and...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Robert Half Management Resources (Los Angeles, CA)
- Description We are in search of a meticulous Sr. Auditor to join our healthcare team in Los Angeles, California. The role involves auditing various aspects of ... our healthcare operations, including hospital departments, billing issues, and charge...and manage documentation * Experience in medical chart and claims audits * Familiarity with auditing practices and procedures… more
- Robert Half Accountemps (Alhambra, CA)
- …are seeking a Medical Chart Auditor to join our team in the Healthcare industry, located in Alhambra, California. This role offers a contract to hire employment ... * Verify and adjust edits in the Patient Accounting System or claims editing system. * Conduct insurance audits alongside selected payer auditors. *… more
- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Provider Documentation Trainer and Auditor , you will be an expert in risk adjustment coding and documentation, ... and a Certified Risk Adjustment Coder (CRC), required + Bachelor's degree ( healthcare or relevant field) or equivalent experience/training + Five or more years… more
- Nuvance Health (Danbury, CT)
- …(SACO) Physician Audit & Billing, the Senior Inpatient Professional Auditor providesHospital Inpatient and Outpatient coding, billing, and documentation auditing ... and State guidelines. Ensure correct DRG and APC assignments for Institutional claims . 2. Maintains confidentiality of protected health information and other forms… more
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