- Prime Therapeutics (Columbus, OH)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Pharmacy Claims Auditor **Job Description** The Pharmacy Claims Auditor is ... responsible for the selection and auditing of claims , educating Prime's network pharmacies and driving contract compliance, and supporting downstream claim … 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: ... to achieve that purpose. Job Summary The Financial Compliance Auditor III Claims is responsible for various...This position is responsible for all aspects of assigned claim audits, including audit testing and completion of the… 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 ... + Performs routine and complex audits on phone calls and claims adjudication. + Researches claim processing problems and errors to determine their origin and… more
- CHS (Clearwater, FL)
- **Overview** ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical ... kneeling, stooping and lifting up to thirty (30) pounds. ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** PA123 **Job Locations**… more
- Conduent (Dallas, TX)
- …in depth pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety of pharmacy records ... a CPhT certification?** **Would you like to audit pharmacy claims for accuracy?** **About the Role** Conduent Payment Integrity...claim data. This is to ensure billed pharmacy claims are being accurately submitted. You will also be… 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 ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … more
- Robert Half Accountemps (Los Angeles, CA)
- …near Los Angeles is seeking a detail-oriented and experienced Medical Clinical Trial Claims Auditor . This role involves meticulous oversight and auditing of ... claims related to our clinical trials to ensure compliance...Medical Denials, Clinical Trial Operations, Clinical trial management, Medical Claims , Claims audits, Coding Audits Robert Half… more
- ManpowerGroup (New York, NY)
- Jefferson Wells is seeking an experienced **Insurance Auditor with Life Claims ** expertise to join our team. The successful candidate will be responsible for ... compliance with company policies, industry standards, and regulatory requirements. The auditor will analyze the claims documentation and processes, identify… more
- New York State Civil Service (Kew Gardens, NY)
- NY HELP Yes Agency Taxation & Finance, State Title Auditor 1 (Tax)/ Auditor Trainee 1 (Tax)/ Auditor Trainee 2 (Tax) (NY HELPS) Occupational Category ... Kew Gardens State NY Zip Code 11415 Duties Description Auditor 1 (Tax) performs on-site field audits and examinations...and advocate disputed cases at BCMS conferences and Small Claims Hearings. May participate at hearings as a witness… more
- Elevance Health (Indianapolis, IN)
- …claim identification, and documentation purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside of the concept ... **DRG Coding Auditor (DIAGNOSTIC RELATED GROUP)** _This position will work...auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all… more
- TEKsystems (Chesapeake, VA)
- …With direction from the Patient Financial Services Director, the Nurse Auditor / Revenue Integrity/CDM Analyst is responsible for performing audits of itemized ... record and other applicable hospital documentation, assigning modifiers to appropriate claims , researching edited claims for medical necessity, and advising… more
- Health Advocates Network (Phoenix, AZ)
- Contract **Job # 24538 Charge Auditor ** **Acclivity Healthcare - Your personable, proven partner!** Since 1999, Acclivity Healthcare has served the specialized ... of better talent. **Compensation and Schedule for the Charge Auditor ** Charge Auditor - Full-time, work-from-home, $25-$35...- Work with Audit and Education Specialists to assist claim audits and understanding on missed charges based on… more
- ManpowerGroup (Vienna, VA)
- Our client, is seeking a Bank and Corporate Owned Life Insurance (BOLI/COLI) Auditor to join their team. As a Bank and Corporate Owned Life Insurance (BOLI/COLI) ... Auditor , you will be part of the Audit Services...policies. + Conduct thorough audits of life and death claims to verify accuracy, completeness, and compliance with company… more
- State of Massachusetts (Everett, MA)
- …financial reporting. The School Business Services unit is seeking an experienced auditor who will be responsible for establishing, monitoring and auditing various ... complex spreadsheets for tracking, reporting and auditing grants and Circuit Breaker claims ; Review, analyze, and manipulate data in various formats to assist with… 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
- 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
- City of New York (New York, NY)
- …As such, DCAS/Audit and Compliance Services seeks to hire a Vendor Contract Auditor to coordinate, monitor and conduct reviews of audit work performed by contracted ... master contracts under the purview of a Senior Staff Auditor /Supervisor and the Audit Director. Responsibilities for the Internal...of vendor contract and/or financial auditing, and auditing of claims for payment to assess their validity on a… more
- Elevance Health (Richmond, VA)
- **Pharmacy Internal Auditor ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our ... lens, to deliver member-centered, lasting pharmacy care. The **Pharmacy Internal Auditor ** is responsible for driving service quality excellence by evaluating the… more
- Robert Half Accountemps (Los Angeles, CA)
- …for verifying, rectifying, and finalizing edits in the Patient Accounting System or claims editing system. The Chart Auditor will occasionally conduct insurance ... on randomly selected accounts monthly. * Work consistently on DNFB and PFS claim edits worklists to ensure timely completion. * Provide support to the Director… more
- Catholic Health Initiatives (Chattanooga, TN)
- …with us today! **Responsibilities** **Job Summary / Purpose** The Sr Coding Compliance Auditor is responsible for reviewing chart notes for proper coding with an ... met at the highest level. The Sr Coding Compliance Auditor 's primary focus will be to facilitate and ensure...other portion of time focused on provider communication, and claims denial resolutions. Communicates denial trends to leadership and… more
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