- Catholic Health Initiatives (Chattanooga, TN)
- …Coders (AAPC) as a Certified Professional Coder (CPC) required. Professional Medical Auditor Certification (CPMA) (CMAS)-preferred but not required. CRC ... with us today! **Responsibilities** **Job Summary / Purpose** The Sr Coding Compliance Auditor is responsible for reviewing chart notes for proper coding with an… more
- Fallon Health (Worcester, MA)
- …is preferred **License/Certifications:** Willingness to pursue a CIA-Certified Internal Auditor certification , or industry certification **Experience:** ... all aspects of audits following departmental standards and procedures. **The Internal Auditor will perform or assist in the following:** + Supports the internal… more
- 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
- 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 ... and valued every day. **Do you have a CPhT certification ?** **Would you like to audit pharmacy claims...claim data. This is to ensure billed pharmacy claims are being accurately submitted. You will also be… more
- ManpowerGroup (Vienna, VA)
- …of life insurance products + In-depth knowledge of life insurance products, claims processes, and regulatory compliance requirements. + Certification in ... seeking a Bank and Corporate Owned Life Insurance (BOLI/COLI) Auditor to join their team. As a Bank and...policies. + Conduct thorough audits of life and death claims to verify accuracy, completeness, and compliance with company… 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
- State of Georgia (Fulton County, GA)
- …the minimum qualifications, meet one or more of the following: . Audit experience in medical claims and/or claims data. . Certification as a CPA or a CFE ... Investigative Auditor - Medicaid Fraud Georgia - Fulton -...an accounting degree as well as auditing experience, medical claims and/or claims data. Certification … more
- City of Detroit (Detroit, MI)
- …Requirements: State of Michigan registration as a Certified Public Accountant or certification as a Certified Internal Auditor is preferred. Knowledge, Skills, ... Director of Internal Audit ( Auditor Manager 3) Print (https://www.governmentjobs.com/careers/detroit/jobs/newprint/4745404) Apply Director of Internal Audit (… 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 ... includes compliance with the Conditions of Participation for CMS. The DRG auditor is responsible for ensuring coding accuracy, coding consistency and efficiency in… more
- Elevance Health (Columbus, OH)
- **Clinical Provider Auditor II** **Supports the Payment Integrity line of business** _Location:_ Alternate locations may be considered. This position will work in a ... recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Provider Auditor II** is responsible for identifying issues and/or entities that… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …the Audit, Risk Management & Information Security (ARMIS) team, the Senior Internal Auditor will perform and support audits and assessments related to financial and ... to Sarbanes-Oxley), risk-based audits, and consulting engagements. The Senior Internal Auditor will participate in cross-functional projects with IT Audit, Risk… more
- Sedgwick (Knoxville, TN)
- …Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Internal Auditor **PRIMARY PURPOSE:** To perform IT internal audit procedures under general ... and to assist in supporting the Company's ISO 27001 certification . **ARE YOU AN IDEAL CANDIDATE?** We are looking...with major in Information Systems preferred. Certified Information Systems Auditor (CISA), Certified Internal Auditor (CIA), or… more
- Highmark Health (Harrisburg, PA)
- …and ensures compliance with DRG/APC structure and regulatory requirements. Performs periodic claim form reviews to check code transfer accuracy from the abstracting ... as assigned. **QUALIFICATIONS:** Minimum + High school diploma / GED + Certification from American Academy of Professional Coders (AAPC) or American Health… more
- Community Health Systems (Sarasota, FL)
- (Full-Time, Remote) The Clinical Review Auditor is a professionally licensed nurse/LPN who is responsible for effectively managing the denial/appeal process via the ... performance of comprehensive analytic reviews of clinical and claim documentation. The CRA will perform triage, determine payment...in a dynamic changing environment. As an Clinical Review Auditor at Community Health Systems, you'll play a vital… 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 ... to ensure compliance. + + Reviews information from third party payers relative to claims charging, coding, and billing in order to ensure compliance. + + Performs… more
- TEKsystems (Norfolk, VA)
- Remote Hospital Charge/Coding Auditor Fully remote with equipment provided!! Must live within 2.5 hours of Chesapeake, VA. You'll enjoy Standard Hours - training ... and other applicablehospital documentation . Assigning modifiers to appropriate claims . Researching edited claims for medical...Core Experience: . Must have CPC or another coding certification . 3+ years of coding experience preferred Pay… 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 ... to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority. Minimum Experience: Three (3) to five… more
- McLaren Health Care (Indianapolis, IN)
- We are looking for a Special Investigative Unit Auditor to join us in leading our organization forward. McLaren Integrated HMO Group (MIG), a division of McLaren ... function. **Preferred:** + Bachelor's Degree in business, health care or related field. + Certification such as RHIT, RHIA, AHFI, CFE, CPMA or CPC. + Two (2) 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
- Atlantic Health System (Morristown, NJ)
- …Follows up with providers as needed until documentation improves 12. Assists with claim denial reports to ensure optimal reimbursement 13. Serves as a resource to ... 14. Provides clarification on coding and compliance policies Required: 1. CPC Certification 2. Minimum 6 months experience in similar role highly preferred 3.… more