- Elevance Health (Boston, MA)
- ** Claims Auditor I, II and Senior**...and post payment and adjudication audits of high dollar claims for limited lines of business, claim ... an accommodation is granted as required by law._ The ** Claims Auditor I** is responsible for pre...an impact :** + Performs audits of high dollar claims . + Ensures claim payment accuracy by… more
- Marshfield Clinic (Marshfield, WI)
- …come together to support the most exciting missions in the world!** **Job Title:** Claims Auditor (Remote - WI or MN) **Cost Center:** 682891379 SHP- Claims ... (United States of America) **Job Description:** **JOB SUMMARY** The Claims Auditor is responsible for performing payment,... has working knowledge of the overall aspects of claim processing, both in and outside of Security Health… more
- UCLA Health (Los Angeles, CA)
- …to the next level. You can do all this and more at UCLA Health. The Claims Quality Auditor will be responsible for the daily audit of all examiners assigned ... to the auditor . You will review claims (paid, pending,...+ Computer proficiency with Microsoft Office + Knowledge of claims adjudication systems + Flexibility and adaptability… more
- US Tech Solutions (Whittier, CA)
- …: Day** **Next Start date: Immediately** **Contract length: 3 months** **POSITION SUMMARY** The Claims Auditor assists in the Claims Department by analyzing ... ensures appropriate payment of claims and maintenance of the claims system as necessary. **SPECIFIC SKILLS NEEDED** Knowledge of HMO/or IPA operations;… more
- Cedars-Sinai (Los Angeles, CA)
- …fuels innovation. **Req ID** : 13340 **Working Title** : Outpatient Surgical and Claims Edit Auditor **Department** : CSRC Coding Audit **Business Entity** : ... of the Year. This award recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement....will I be doing in this role?** The Coding Auditor works under the general direction of the Coding… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …including basic analysis of identified trends. + Analyzes audit results to recommend system or procedural changes to increase claim accuracy and/or identify ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … 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 ... cost reduction, by increasing the accuracy of provider contract payments in our payer systems , and by ensuring correct claims payment for appropriate CPT/ HCPCS… more
- UPMC (Pittsburgh, PA)
- …in person or virtual recipient restriction hearings. + Review Medical Pended Queue claims to understand and resolve claim referral issues through research and ... UPMC Health Plan has an exciting opportunity for a Clinical Auditor /Analyst Intermediate! The Clinical Auditor /Analyst Intermediate is an integral part of the… more
- Elevance Health (Chicago, IL)
- …documentation purposes (eg, letter writing) on lower level auditors. + Identifies new claim types by identifying potential claims outside of the concept where ... **DRG Coding Auditor Principal** **_Virtual: _** _ _ This role...preferred. + Broad, deep and niche knowledge of medical claims billing/payment systems provider billing guidelines, payer… more
- New York State Civil Service (Hauppauge, NY)
- NY HELP Yes Agency Taxation & Finance, State Title Auditor 1 (Tax)/ Auditor Trainee 1 (Tax)/ Auditor Trainee 2 (Tax) (NY HELPS) Occupational Category ... City Hauppauge State NY Zip Code 11788 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
- New York State Civil Service (White Plains, NY)
- NY HELP Yes Agency Taxation & Finance, State Title Auditor 1 (Tax)/ Auditor Trainee 1 (Tax)/ Auditor Trainee 2 (Tax) (NY HELPS) Criminal Investigations ... authority;.Represent CID and advocate disputed cases at BCMS conferences and Small Claims .Hearings; may participate at hearings as a witness for the Department… more
- Elevance Health (Ashburn, VA)
- …claim identification, and documentation purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside of the concept ... or quality assurance environment preferred. + Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement… more
- AmeriHealth Caritas (Philadelphia, PA)
- … claims experience and auditing experience + Minimum of 3 years of system configuration experience + Facets claim processing knowledge required + Microsoft ... communicate the audit outcome to the appropriate persons. The auditor will validate production to ensure that the case...will be expected to build/run complex queries to identify claims affected by the configuration change and analyze all… more
- Humana (Columbus, OH)
- …evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle ... 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
- The Cigna Group (Detroit, MI)
- The Pharmacy Auditor is responsible for identifying pharmacy audit risks using analytical skills and audit tools, and for developing and executing audit plans and ... the scope of procedures necessary to address those risks. The Staff Auditor will complete audits to address identified risks and present findings to the Sr Audit… more
- MAPFRE Insurance (Webster, MA)
- …designation, Certified Internal Auditor (CIA) designation or Certified Information Systems Auditor (CISA) designation preferred + 1-2 years of insurance ... Internal Auditor (Webster or Boston, MA) Date: Nov 22,...industry knowledge ( Claims , Underwriting, Insurance Operations, etc.)An understanding of internal audit… more
- Robert Half Finance & Accounting (Kansas City, MO)
- Description We are seeking a skilled Revenue Systems Auditor to lead compliance assurance and auditing functions across Skilled Nursing and Senior Living ... billing and trust account activities. + Diagnose and resolve system issues that affect claim processing and...Diagnose and resolve system issues that affect claim processing and payments, introducing improvements to support workflow… more
- Saint Francis Health System (Tulsa, OK)
- …**to login and apply.** Full Time Days Job Summary: The Compliance Nurse Auditor assists with and supports the compliance program activities within Saint Francis ... Health System (SFHS). This role supports clinical coding and billing...the patient chart supports items and services included on claims and accurately supports reasons for treatment, billing, payment,… more
- Insight Global (South Jordan, UT)
- …valid claim identification and documentation (letter writing). Identifies potential claims outside of the concept where additional recoveries may be available. ... Job Description Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100%...AP-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer… more
- Elevance Health (Chicago, IL)
- …preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems , provider billing guidelines, payer ... **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This...Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes… more