- 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 ... downstream claim corrections and eliminate potential waste. **Responsibilities** + Validate claim documentation and systems data to ensure claim was… 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...members, providers, billing departments, and other insurance companies regarding claims . + Documents phone calls in system … more
- CHS (Clearwater, FL)
- **Overview** ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical ... Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) to determine proper category for benefit code...and lifting up to thirty (30) pounds. ** ** ** Claims and Call Auditor (Call Center QC)… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Claims Auditor 75 Vanderbilt Ave, Staten...of identified trends. + Analyzes audit results to recommend system or procedural changes to increase claim ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … more
- State of Michigan (Lansing, MI)
- …of a Certified Internal Auditor certification or a Certified Information System Auditor certification may be substituted for one year of experience ... Accountant (CPA) + Certified Internal Auditor (CIA) + Certified Information System Auditor (CISA) + Global Management Accountant (CGMA) + Certified… more
- TEKsystems (Chesapeake, VA)
- …Ensure accuracy and integrity of charge data prior to billing interface and claims submission Utilize a computerized encoding system to facilitate accurate ... and procedural information from the record using ICD-10-CM and CPT-4/HCPCS classification systems . Utilize a computerized encoding system to facilitate accurate… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …+ Ensure accuracy and integrity of charge data prior to billing interface and claims submission + Utilize a computerized encoding system to facilitate accurate ... and procedural information from the record using ICD-10-CM and CPT-4/HCPCS classification systems . Utilize a computerized encoding system to facilitate accurate… 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...quality assurance environment preferred. + Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer… more
- BayCare Health System (Tampa, FL)
- …7:00 AM to 3:30 PM + **Days:** Monday - Friday The **Inpatient** **Coding Auditor ** is a full-time remote position. This team member must currently reside in ... _Sign on bonuses available!_ **Responsibilities** + The Inpatient Coding Auditor performs inpatient encounter audits and evaluates compliance related activities… more
- Community Health Systems (Sarasota, FL)
- …care delivered to patients in a dynamic changing environment. As an Clinical Review Auditor at Community Health Systems , you'll play a vital role in supporting ... (Full-Time, Remote) The Clinical Review Auditor is a professionally licensed nurse/LPN who is...the performance of comprehensive analytic reviews of clinical and claim documentation. The CRA will perform triage, determine payment… more
- Elevance Health (Latham, NY)
- …policies and procedures on a daily basis. This review includes complex behavioral health claim claims that require additional research and resolution as well as ... The **Performance** **Quality Auditor ** is responsible for evaluating the quality of...appropriate feedback to claims processors via the claims audit database documentation system . + Report… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …. Ensure accuracy and integrity of charge data prior to billing interface and claims submission . Utilize a computerized encoding system to facilitate accurate ... and procedural information from the record using ICD-10-CM and CPT-4/HCPCS classification systems . Utilize a computerized encoding system to facilitate accurate… 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 ... help us put health first The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical...the accuracy of provider contract payments in our payer systems , and by ensuring correct claims payment… more
- Robert Half Accountemps (Los Angeles, CA)
- …verifying, rectifying, and finalizing edits in the Patient Accounting System or claims editing system . The Chart Auditor will occasionally conduct ... on randomly selected accounts monthly. * Work consistently on DNFB and PFS claim edits worklists to ensure timely completion. * Provide support to the Director… 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
- 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
- Bon Secours Mercy Health (Cincinnati, OH)
- …assessment reports, internal quality control reviews, internal and external third party claims payment peer analysis systems to detect provider-billing trends, ... review of Bon Secours Mercy Health coding, billing and claims processing policies and procedures for the development of...+ Assists in auditing and investigations requested by the System Director, Compliance. + Assists in the development of… 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