- 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
- LA Care Health Plan (Los Angeles, CA)
- Financial Compliance Auditor III Claims Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: ... the safety net required to achieve that purpose. Job Summary The Financial Compliance Auditor III Claims is responsible for various tasks within the Financial… more
- CHS (Clearwater, FL)
- **Overview** ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical ... processing. + Reviews Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) to determine proper...and lifting up to thirty (30) pounds. ** ** ** Claims and Call Auditor (Call Center QC)… more
- University of Utah Health (Murray, UT)
- …responsible for auditing claims and customer service calls for UUHP. + The Claims and Customer Service Auditor reviews claims for processing accuracy in ... Overview: University of Utah Health is an integrated academic healthcare system with five hospitals including a level 1...Performs routine and complex audits on phone calls and claims adjudication. + Researches claim processing problems and errors… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Claims Auditor 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #1153 Monday, December 2, 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
- Conduent (Philadelphia, PA)
- …pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor , you will examine a wide variety of pharmacy records against our ... a CPhT certification?** **Would you like to audit pharmacy claims for accuracy?** **About the Role** Conduent Payment Integrity...pharmacy claim data. This is to ensure billed pharmacy claims are being accurately submitted. You will also be… 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
- Chesapeake Regional Healthcare (Chesapeake, VA)
- Job Summary With direction from the Director, the Nurse Auditor /Revenue Integrity Specialist is responsible for auditing itemized charges versus the patient medical ... record and other applicable hospital documentation, assigning modifiers to appropriate claims , researching edited claims for medical necessity, and advising 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
- 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
- Elevance Health (Louisville, KY)
- …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
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided to ensure ... correct coding guidelines are met. The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the… more
- Elevance Health (St. Louis, MO)
- **DRG Coding Auditor (DIAGNOSTIC RELATED GROUP)** _This position will work virtually._ _Alternate locations may be considered._ _The Ideal candidate must live within ... recover, eliminate and prevent unnecessary medical-expense spending. The **DRG Coding Auditor ** is responsible for auditing inpatient medical records and generating… 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 (Metairie, LA)
- **Diagnosis Related Group Clinical Validation Auditor -** **Registered Nurse** **Location:** This position will work a hybrid model (remote and office). Ideal ... 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 (Hanover, 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
- Covenant Health Inc. (Knoxville, TN)
- Overview Inpatient Coding Auditor and Educator, Centralized Coding Full-Time, 80 Hours per pay period, Day Shift Covenant Health Overview: Covenant Health is East ... Tennessee's top-performing healthcare network with 10 hospitals (http://www.covenanthealth.com/hospitals/) and over 85...+ Reviews information from third party payers relative to claims charging, coding, and billing in order to ensure… more
- New York State Civil Service (Albany, NY)
- …HELP No Agency Attorney General, Office of the Title Forensic Auditor : Entry-Level, Investigate Medicaid Fraud (6354) Occupational Category Financial, Accounting, ... of Criminal Justice Medicaid Fraud Control Unit - AlbanyForensic Accountant/ Auditor Reference No. MFCU_ALB_FAA_6354Application Deadline: February 7, 2025Salary Range:… more
- Prime Therapeutics (Columbus, OH)
- …our passion and drives every decision we make. **Job Posting Title** Senior Internal Auditor - SOC1 - Remote **Job Description** The Senior Internal Auditor ... Assess the design and operating effectiveness of internal controls related to claims and rebate processing designed to mitigate risk and support SOC1 objectives.… more
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