- Elevance Health (Grand Prairie, TX)
- Performance Quality Analyst II Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... granted as required by law. The Performance Quality Analyst II is responsible for driving service quality excellence by...Included are processes related to enrollment and billing and claims processing, as well as customer service written and… more
- Healthfirst (NY)
- …+ **Conduct moderately complex to complex quality audits of provider claims , pre-payments and post-payments including high-dollar and specialized claims ... to ensure the quality of the network.** + **Review and investigate claims and encounters for medical, facility, pharmacy, dental and vision services including… more
- City of New York (New York, NY)
- Job Description APPLICANTS MUST BE PERMANENT IN THE MANAGEMENT AUDITOR CIVIL SERVICE TITLE OR BE PERMANENT IN A COMPARABLE TITLE ELIGIBLE FOR 6.1.9 TITLE CHANGE. IF ... YOU ARE HIRED PROVISIONALLY AS A MANAGEMENT AUDITOR , YOU MUST TAKE AND PASS THE MANAGEMENT ...standard audit procedures examine records and documents that support claims submitted to Medicaid for reimbursement for goods or… more
- The County of Los Angeles (Los Angeles, CA)
- LAW ENFORCEMENT AUDITOR Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4668332) Apply LAW ENFORCEMENT AUDITOR Salary $109,807.68 - ... professional auditing standards in a law enforcement agency. OPTION II : Three years of professional auditing experience, with a...No 10 In the execution of the Law Enforcement Auditor duties, you will have to make site visits… more
- Highmark Health (Harrisburg, PA)
- …coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure ... + Validates the ICD-CM, ICD-PCS, CPT and HCPCS Level II code and modifier systems, missed secondary diagnoses and...Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA) + 5 years with hospital or physician… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in a clear and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. + Manages cases as assigned, ... + Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) + Performs...Directors and/or clinical consultants. + Serves as an internal auditor /peer reviewer for new clinical staff, as needed. +… more
- The County of Los Angeles (Los Angeles, CA)
- …permanent appointment to Health Care Financial Analyst. DEFINITION: Prepares reimbursement claims for health and/or mental health care provided under Federal, State ... requirements for Federal, State, and/or Special Programs to determine if claims for reimbursement conform to applicable rules and regulations and result… more
- The County of Los Angeles (Los Angeles, CA)
- …requirements for Federal, State, and/or Special Programs to determine if claims for reimbursement conform to applicable rules and regulations and result ... Health Services or Mental Health, departmental administration and by the Auditor -Controller when necessary. Writes policy and procedure manuals pertinent to… more
- RKON (Chicago, IL)
- About us: RKON is an ISO27001 and AICPA SOC 2 Type II certified company that specializes in providing IT migration and transformation services for the Mergers and ... access management and zero trust strategies. + Cyber insurance readiness and claims advisory. + M&A cyber due diligence and post-close security integration. +… more
