- Harbor Health Services, Inc. (Mattapan, MA)
- …requirements, as well as state and federal regulatory requirements; maintains audit -ready status. Creates a continuous learning culture and leads improvement of ... understand provider experience and develops external partnerships with provider and healthcare organizations, including hospitals and SNFs. Serves as coach and… more
- CenterWell (Atlanta, GA)
- …the organization's pre-billing function. This role is responsible for ensuring all claims are audit -ready prior to release, driving standardization across ... pre-billing function. This role is responsible for ensuring all claims are audit -ready prior to release, driving...make an impact** **Required Skills:** + Bachelor's degree in healthcare administration, business, or a related field; in lieu… 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, ... claims errors. + Prepares, tracks and provides claims audit findings reports according to established...position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina… more
- Guidehouse (San Marcos, CA)
- …is expected to perform all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims . Must work with other ... Billing Emphasis + Correcting and billing electronic and hardcopy claims + Submits Adjusted claims + Provides...or insurance information. + Works all rejection and payer audit reports within 48 hours of receipt taking whatever… more
- HCA Healthcare (Nashville, TN)
- …In addition, the position is responsible for training and providing direction to Claims Examiners and Audit Research personnel. **DUTIES INCLUDE BUT NOT LIMITED ... Are you passionate about the patient experience? At HCA Healthcare , we are committed to caring for patients with...We care like family! Jump-start your career as a Claims Operations Lead today with Work from Home. **Benefits**… more
- Prime Healthcare (Ontario, CA)
- …improve the quality and minimize process cost of Claims for all Prime Healthcare 's self-insured Employee Health Plans. Through in-depth audit and review of ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/227013/vice-president-of-health-plan-operations-and- claims /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime … more
- Molina Healthcare (Kearney, NE)
- JOB DESCRIPTION Job Summary Provides support for claims recovery activities including researching claim payment and billing guidelines, audit results, and ... to facilitate recovery of outstanding overpayments. Monitors and controls backlog and workflow of claims and ensures that claims are settled in a timely fashion… more
- Grant Thornton (Newport Beach, CA)
- As a Healthcare Process Risk Senior Associate, you will get the opportunity to grow and contribute to our clients' business needs by helping them understand their ... The ideal candidate will have exceptional expertise and experience in healthcare providers, specifically hospitals, academic medical centers, and healthcare … more
- Humana (Madison, WI)
- …reports and submitting for adjustments** + **Cross trained in multiple areas within the Claims Department** + **Provide audit support** As part of our hiring ... caring community and help us put health first** The Claims Research & Resolution Representative 3 manages claims...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also… more
- Centene Corporation (Indianapolis, IN)
- …issues and inquiries. + Track claims quality trends and review Internal Audit claims quality results (with a focus centered on manual errors); coordinate ... or CPT.** **Position Purpose** Manage the prospective review of high risk claims to ensure payment integrity and provide immediate feedback on findings including… more
- Henry Ford Health System (Detroit, MI)
- …and general liability, workers compensation and employers liability claims review, investigation, management and disposition, including financial mitigation ... and management of System reputation Will work under the guidance of Senior Claims Managers, Senior Claims Consultant, Director of Insurance, and Vice President,… more
- DoorDash (Tempe, AZ)
- …company's bottom line. The team is divided into three separate subgroups: Actuarial, Claims Operations, and Risk Management & Mitigation. We are looking for forward ... cross-functional partners at DoorDash. About the Role We are seeking an experienced claims specialist who will be a member of DoorDash's Corporate Risk & Insurance… more
- Dignity Health (Bakersfield, CA)
- …or GED + Minimum 5 years of progressive experience in healthcare claims recovery, payment integrity, or post-payment audit functions, preferably within a ... **Job Summary and Responsibilities** The Claims Recovery Manager is responsible for leading the...The Recovery Manager works in close coordination with internal audit , provider dispute resolution, and finance to maximize cost… more
- Bayer (Whippany, NJ)
- …to make a real difference, there's only one choice.** **Assoc Dir GTN Audit & Compliance** **YOUR TASKS AND RESPONSIBILITIES** The primary responsibilities of this ... role, Associate Director GTN Audit , Compliance and Performance are to: The Associate Director...following rationale for conducting customer audits: 1. **Accuracy of Claims ** : To ensure proper reimbursement and prevent revenue… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … more
- AbbVie (North Chicago, IL)
- …of the different industries and associated business models. The Global Compliance Audit Associate Director has the primary function to lead/manage global sales and ... marketing, corporate functions, and other healthcare compliance audits. The role will assist the Director...business risks for US/International locations and recommend a thoughtful audit approach. The role will also manage the … more
- Elevance Health (Hanover, MD)
- Manager of DRG Coding Audit -Program/Project Locations: _The selected candidate must reside within a reasonable commuting distance of the designated posting ... and prevent unnecessary medical-expense spending. The **Manager of DRG Coding Audit ** leads a high-performing team responsible for auditing inpatient medical records… more
- Molina Healthcare (Buffalo, NY)
- …combination of education and experience **PREFERRED EXPERIENCE:** 3+ years healthcare Medical claims auditing **PHYSICAL DEMANDS:** Working environment ... hours will be 7am-3:30pm PST M-F** **Job Summary** Responsible for conducting various healthcare Healthcare claim audits including, but not limited to; vendor,… more
- Emory Healthcare/Emory University (Atlanta, GA)
- **Overview** **Be inspired** **.** **Be rewarded. Belong. At Emory Healthcare .** At Emory Healthcare we fuel your professional journey with better benefits, ... The Compliance & Privacy Partner reports to the Chief Compliance Officer of Emory Healthcare (CCO EHC) and is responsible for supporting the daily operations of the… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …can contribute to the excellence of our academic community. **Description** **Transform Healthcare Finance at Scale** Emory Health Plan seeks an exceptional finance ... strategy, build scalable infrastructure, and shape the future of healthcare delivery during the most dynamic period in the...+ Scale analytics infrastructure from 20M to 35-40M annual claims with advanced predictive modeling and machine learning +… more
