- Centers Plan for Healthy Living (Staten Island, NY)
- Claims Auditor 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #1153 Monday, October 7, 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
- HCA Healthcare (Nashville, TN)
- … like you to be a part of our team. **Job Summary and Qualifications** The Claims Auditor will serve as a Subject Matter Expert (SME) in medical claims ... an organization that invests in you as a **Claim Auditor ** ? At Work from Home, you come first. HCA Healthcare has committed up to $300 million in programs to… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- Summary With direction from the Patient Financial Services Director, the Nurse Auditor / Revenue Integrity/ CDM Analyst is responsible for performing audits of ... record and other applicable hospital documentation, assigning modifiers to appropriate claims , researching edited claims for medical necessity, and advising… 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
- 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
- Humana (Columbus, OH)
- …**Where you Come In** Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider ... caring community and help us put health first The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns… 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 **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
- Robert Half Accountemps (Alhambra, CA)
- …are seeking a Medical Chart Auditor to join our team in the Healthcare industry, located in Los Angeles, California. This role offers a contract to hire ... and finalizing edits in the Patient Accounting System or claims editing system. The Chart Auditor will...System or claims editing system. The Chart Auditor will occasionally conduct insurance audits in conjunction with… more
- Elevance Health (Manchester, NH)
- …to accurately document determinations and continue to the next step in the claims lifecycle. + Researches new healthcare -related questions as necessary to aid ... **Clinical Provider Auditor I - Carelon Payment Integrity** **Location:** The...abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines… more
- Elevance Health (MD)
- …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 I** **Supports Payment Integrity & Behavioral Health**...abuse. **How will you make an impact:** + Examines claims for compliance with relevant billing and processing guidelines… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- Ready to help us transform healthcare ? Bring your true colors to blue. We What Need As a valued member of the Audit, Risk Management & Information Security (ARMIS) ... team, the Senior Internal Auditor will perform and support audits and assessments related...and risk-based audits of these areas (eg Enrollment, Premiums, Claims Operations, Provider Enrollment and Pricing, Accounting, and Information… more
- Elevance Health (Houston, TX)
- **Clinical Provider Auditor Senior** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of ... our PulsePoint locations. The **Clinical Provider Auditor Sr** will be responsible for identifying issues and/or...abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines… more
- Idaho Division of Human Resources (Boise, ID)
- Medicaid Fraud Control Unit Investigative Auditor , OAG Posting Begin Date: 2024/10/17 Posting End Date: 2024/12/20 Category: Audit Sub Category: Program Management ... easy access. Primary Duties: The successful applicant for the the Investigative Auditor position will be assigned to the Attorney General's Medicaid Fraud Control… 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
- Covenant Health Inc. (Knoxville, TN)
- …to ensure compliance. + Reviews information from third party payers relative to claims charging, coding, and billing in order to ensure compliance. + Performs ... inpatient and out-patient and/or physician practice. Good working knowledge of healthcare billing, Medicare/Medicaid billing guidelines, and other Third Party Payor… 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
- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will ... be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and...+ Certified Inpatient Coder (CIC) + Certified Professional Medical Auditor (CPMA) **Desired Education (nice to have):** + Masters… more
- DoorDash (Tempe, AZ)
- …on our bottom line. The team is divided into multiple subgroups: Actuarial, Claims Operations, and Risk Management. We are looking for individuals eager to help ... About the Role DoorDash is seeking an experienced Insurance Claims Supervisor to join its Corporate Risk and Insurance...The Covey tool has been reviewed by an independent auditor . Results of the audit may be viewed here:… 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 ... DoorDash. About the Role We are seeking an experienced claims specialist who will be a member of DoorDash's...The Covey tool has been reviewed by an independent auditor . Results of the audit may be viewed here:… more
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