- Prime Therapeutics (Providence, RI)
- …purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Pharmacy Claims Auditor - Remote Job Description The Pharmacy Claims ... analysis of large datasets and audit findings to detect high-risk pharmacy claims , identify billing irregularities, and uncover patters of non-compliance or systemic… more
- Lyric (Newtown Square, PA)
- … editing solution, as a payment, reimbursement or medical policy analyst, medical claims processor, chart auditor /reviewer, or claims edit/denial management ... leadership skills to guide their team in delivering superior claims edits. The Senior Manager will meet regularly with...subject matter expert on CPT, HCPCS, ICD10CM coding and claims edit logic (including NCCI, LCDs, State Medicaid, MUEs,… more
- Sedgwick (St. Louis, MO)
- …Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Attorney Auditor ** This is a fully remote position, and candidates residing in any of ... States are encouraged to apply. ** As an Attorney Auditor at Sedgwick, you'll have the opportunity to take...other roles. Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating… more
- Elevance Health (Richmond, VA)
- …Make an Extraordinary Impact. Title : Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG) **Virtual: ** _ ?_ This role ... a commuting distance from an office. The DRG Coding Auditor is responsible for auditing inpatient medical records and...auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all… more
- Elevance Health (Washington, DC)
- Title: Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG) Virtual: This role enables associates to work virtually full-time, ... required by law. The Diagnosis Related Group Clinical Validation Auditor -RN is responsible for auditing inpatient medical records to...Specializes in review of Diagnosis Related Group (DRG) paid claims . How you will make an impact: Analyzes and… more
- Lyric (Newtown Square, PA)
- …+ 5 years or more relevant healthcare experience as a medical coder, medical claims processor medical auditor , clinical editing analyst, or payment or medical ... and governmental references, specialty society guidance, industry trends and paid claims data, the New Opportunity Consultant identifies areas where claim… more
- UnitedHealth Group (Minnetonka, MN)
- …to start Caring. Connecting. Growing together . In this position as a DRG/CVA Validation Auditor RN , you will apply your expert knowledge of the MS-DRG and APR-DRG ... Guidelines, and AHA Coding Clinic Guidelines in the auditing of inpatient claims . Employing both industry and Optum proprietary tools, you will validate ICD-10… more
- Warner Music Group (New York, NY)
- …the contractually-defined scope) of the audit concerned; + Review and analyze the audit claims submitted by the auditor in question, as well as the relevant ... including, without limitation, tracking audit notifications, reviewing and analyzing the claims contained in the audit reports we receive, making recommendations to… more
- Molina Healthcare (Salt Lake City, UT)
- …Healthcare claim audits including, but not limited to; vendor, focal, audit the auditor . Confirm that documentation is clear and concise to ensure accuracy in ... auditing of critical information on claims ensuring adherence to business and system requirements of...SKILLS & ABILIITIES: Minimum 2 years as an operational auditor for at least one core operations function Previous… more
- Elevance Health (Grand Prairie, TX)
- …within the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries. How ... you will make an impact: Assists higher level auditor /lead on field work as assigned and acts as...Participates in pre and post implementation audits of providers, claims processing and payment, benefit coding, member and provider… more
- Robert Half (Fairview, OR)
- …Manage all financial activity for grants, including revenue/expense reconciliation, claims , billing, journal entries, documentation, and grant closeout. Work with ... reconciliations. Support annual audits by preparing work papers and responding to auditor requests. Stay current on federal, state, and local funding regulations.… more
- RTX Corporation (Hartford, CT)
- …Trade ! What You Will Do: Support valuation reconciliation. Support drawback claims . Support post summary corrections. Support resolution of problematic imports and ... with US Customs regulations. Knowledge of non-US Customs regulations. Certified Internal Auditor or other like certification is a plus. Six Sigma, Ace, Core… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …as assigned. **What you will bring:** + Four (4) years of customer service, claims or membership and billing experience in a call center, healthcare, or insurance ... difficult people, etc. + Quality certification such as Certified Quality Auditor (CQA), Quality Improvement Associate (CQIA), Quality Process Analyst Certification… more
- Robert Half Accountemps (Boston, MA)
- Description Job Title: Medical Claims Auditor - RN Auditor Location: Massachusetts - 90% Remote Job Type: 1 Year Contract - Potential for Perm Hire Hours: 40 ... 1, 2025 Job Description We are seeking a qualified Auditor with healthcare experience to support Program Integrity activities...perform onsite audits (1-4 times per month) + Evaluate claims and provider documentation for compliance and accuracy +… more
- Kemper (Birmingham, AL)
- …stakeholders that delivers on our promises._ Kemper is excited to be adding to our Claims Auditing Team. Our claims auditor position is responsible for ... and impacting bottom-line results + Maximize value to the claims department through planned partner relationships designed to foster...and casualty insurance and both the auto and homeowners claims adjustment processes. + This person must have the… more
- Conduent (Warren, MI)
- …part of a culture where individuality is noticed and valued every day. **Supplier Claims Auditor ** **Hybrid | Warren, MI** **Part-Time | Hours Assigned as ... Monday- Friday, 7:00 AM - 4:00 PM EST** **About the Role:** As a Supplier Claims Auditor , you'll play a vital role in the Supplier Claim Activity (SCA) group by… 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, and denied) for accuracy, appropriate application of benefits, authorization for services, contract… 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** : ... will I be doing in this role?** The Coding Auditor works under the general direction of the Coding...the general direction of the Coding Supervisor. A Coding Auditor is responsible for reviewing encounters in either a… 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: ... net required to achieve that purpose. Job Summary The Financial Compliance Auditor III Claims is responsible for audits of claims processed by Delegated… more
- Molina Healthcare (Albany, NY)
- JOB DESCRIPTION Job Summary Provides support for claims audit activities including identification of incorrect coding, abuse and fraudulent billing practices, waste, ... overpayments, and claims processing errors. **Essential Job Duties** + Audits the...errors. **Essential Job Duties** + Audits the adjudication of claims using standard principles, and state-specific regulations to identify… more
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