- HCA Healthcare (Nashville, TN)
- … like you to be a part of our team. **Job Summary and Qualifications** The Claims Auditor will serve as a Subject Matter Expert (SME) in medical claims ... an organization that invests in you as a **Claim Auditor ** ? At Work from Home, you come first....What you will do: + Perform concurrent and retrospective review of paper & electronic claims processed… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Claims Auditor 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #1153 Tuesday, November 5, 2024 Centers Plan for Healthy Living's goal is to create the ... their use and identifying any deficiencies. + Prepare summaries for management of quality review results, including basic analysis of identified trends. +… more
- City of Eugene (Eugene, OR)
- …training. The Police Auditor provides staff support to the all-volunteer Civilian Review Board appointed by the City Council. The Police Auditor 's Office has ... cases, and other cases the Police Auditor determines are appropriate , to the civilian review board and assists them in the review of these cases. + The … more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …timely manner. Perform random quality audits as schedule permits + Work and review a high volume of accounts assigned to Revenue Integrity Nurse Auditor work ... Summary With direction from the Patient Financial Services Director, the Nurse Auditor / Revenue Integrity/ CDM Analyst is responsible for performing audits of… more
- UPMC (Pittsburgh, PA)
- …of clinical experience. + Three years of fraud & abuse, auditing, case management, quality review or chart auditing experience required. + DRG or APR experience ... UPMC Health Plan is looking for an Intermediate Clinical Auditor /Analyst to join the Quality Assurance team!...to analysis of payment policies, prepayment, and post payment review of high dollar claims , and prepayment… more
- Rising Medical Solutions (Chicago, IL)
- …born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in the world of medical cost containment. Join ... + Consistently meet productivity and turn-around time requirements. + Adhere to quality standards, state billing guidelines, HIPAA rules, and confidentiality of all… 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 ... across the medical group. The Hierarchical Condition Category (HCC) Quality program was developed by CMS to promote ...met at the highest level. The Sr Coding Compliance Auditor 's primary focus will be to facilitate and ensure… more
- Hackensack Meridian Health (Hackensack, NJ)
- …ensuring coding accuracy, coding consistency and efficiency in filing of inpatient claims . Collaborates with the Clinical Documentation Quality Liaison to assist ... as a leader of positive change. The **Diagnosis Related Group (DRG) Auditor ** is responsible for auditing clinical documentation that supports code assignment for… more
- Adecco US, Inc. (Chicago, IL)
- …trends, and client processes and requirements . Maintain and manages daily case review assignments, with a high emphasis on quality . Provide clinical ... & Life Sciences is hiring a DRG Validation RN Auditor ! This role is work from home / remote....to successfully substantiate code assignments . Perform clinical coding review to ensure accuracy of medical coding and utilizes… more
- Elevance Health (Denver, CO)
- …clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will ... **Diagnosis Related Group Clinical Validation Auditor ** **Location:** This position will work a hybrid...Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation… more
- ManpowerGroup (Madison, AL)
- …Development processes + Review 3rd party vendor who processes the transport claims + Assist in the process of selecting, onboarding, changes to and termination ... the automotive manufacturing industry, is seeking a Parts Logistics Auditor to join their team. As a Parts Logistics...to providing equal employment opportunities in a professional, high quality work environment. It is the policy of ManpowerGroup… more
- Army National Guard Units (Latham, NY)
- …TITLE 5 EXCEPTED SERVICE POSITION. This National Guard position is for a AUDITOR , Position Description Number T5142P01 and is part of the UNITED STATES PROPERTY ... annuitants. Telework avaialable IAW Agency Policy. Responsibilities As a Auditor , GS-0511-13, you will serve as an agent of...to a major field of study. The nature and quality of this required course work must have been… more
- Continental Resources (Oklahoma City, OK)
- …balloting, testing, monitoring others work, review of peer work, clearing review notes, selling the claims , reporting, billing, and solving the audits ... **Job Summary** The Staff Auditor will lead, conduct, and assist in the...Analyze large datasets using diverse data inputs to provide management- quality outputs and conclusions to provide value to the… more
- Covenant Health Inc. (Knoxville, TN)
- …and/or physician office staff. Serves as a resource to coders, CDI staff, Quality and Case Managers, Decision Support and physician office personnel regarding coding ... + Reviews information from third party payers relative to claims charging, coding, and billing in order to ensure...staff for ICD 10 coding. + Responsible for concurrent review process for ICD-10 coding utilization. + Responsible for… more
- IQVIA (Bridgewater, NJ)
- …as a shared resource in collaboration with various program teams to review both chain and independent pharmacy audit requests. **Principal Accountabilities:** + ... Responsible for conducting pharmacy claims audits at the request of operations and management...Responsible for collaboration with pharmacy facilities to acquire and review documentation necessary for assessing and validating compliance of… more
- Healthfirst (OK)
- …and provide feedback to reduce errors and improve processes and performance to ensure quality . + Review and investigate appeals and grievances requests to ensure ... *This position is Remote + Conduct quality audits of A&G items including grievances, pre-service appeals, and post service appeals utilizing appropriate sources of… more
- Sutherland Global Services (Columbus, OH)
- … needing additional information + Refer problem claims to a Lead and/or auditor for additional review + Make sure that the integrity of the information ... of your day. + Be responsible for effectively adjudicating claims to meet production, quality , and other...for effectively adjudicating claims to meet production, quality , and other metrics in accordance with policy/procedures and… more
- The Cigna Group (Seattle, WA)
- …may recommend changes in processing procedures. **Job Description** The Quality Review and Audit Lead Hybrid Auditor is primarily responsible for using ... knowledge and acumen to develop models and procedures, and monitor trends, within Quality Review and Audit. Using independent judgement and discretion,… more
- Defense Contract Audit Agency (Fort Belvoir, VA)
- …by the President's Council on Integrity and Efficiency (PCIE) and (2) conducting quality assurance related review projects on an Agency-wide basis. - Provides ... the American taxpayer. Responsibilities - The Assistant Director, (AD), Policy, Quality and Legislative Affairs (PQLA), Defense Contract Audit Agency (DCAA)… more
- Reyes Holdings (Milwaukee, WI)
- …quality -related issues. This position focuses on compliance through capability building. The Quality Assurance Manager oversees the review and mitigation of ... to the rule governing the program. Position Summary: The Quality Assurance Manager is the subject matter expert for...management for decision making during a crisis situation + Review audit results and identify the severity of audit… more