• Financial Compliance Auditor III…

    LA Care Health Plan (Los Angeles, CA)
    …tasks within the Financial Compliance Unit, including audit of claims processed by medical groups and health plans contracted with LA Care. This role works ... Financial Compliance Auditor III Claims Job Category: Accounting/Finance...audit results. Perform claims audits for all medical groups and health plans contracted with… more
    LA Care Health Plan (01/04/25)
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  • Claims and Call Auditor (Call Center…

    CHS (Clearwater, FL)
    …(Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical insurance claims and customer service calls to ... and compliance with appropriate policies, procedures, and regulations + ** Health , Dental, Vision, and Life Insurance as well as...and lifting up to thirty (30) pounds. ** ** ** Claims and Call Auditor (Call Center QC)… more
    CHS (12/27/24)
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  • Claims & Customer Service Auditor I

    University of Utah Health (Murray, UT)
    …or the equivalency. + Three years of experience collecting, organizing and maintaining health insurance and processing medical claims , enrollment, and ... and customer service calls for UUHP. + The Claims and Customer Service Auditor reviews ...of the job as outlined above. + Experience with claims processing in a health care delivery… more
    University of Utah Health (01/03/25)
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  • Pharmacy Claims Auditor CPhT

    Conduent (Dallas, TX)
    …in depth pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety of pharmacy records ... a CPhT certification?** **Would you like to audit pharmacy claims for accuracy?** **About the Role** Conduent Payment Integrity...For You** Perks and rewards designed for you: + Health and Welfare Benefits: Our health and… more
    Conduent (01/18/25)
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  • Inpatient Medical Coding Auditor

    Humana (Columbus, OH)
    …part of our caring community and help us put health first The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical ... is looking for an experienced medical coding auditor to review inpatient hospital claims for...years' experience in performing inpatient coding reviews/ audits in health insurance and/or hospital settings * Working knowledge of… more
    Humana (12/12/24)
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  • Clinical Provider Auditor I - Maryland…

    Elevance Health (Hanover, MD)
    **Clinical Provider Auditor I** **Supports Payment Integrity & Behavioral Health ** _Lo_ _cation: This is a field position expected to be in clinic 60% of the ... medical -expense spending. A proud member of the Elevance Health family of companies, Carelon Behavioral Health ,...prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment… more
    Elevance Health (01/08/25)
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  • CDM Analyst RI Auditor

    Chesapeake Regional Healthcare (Chesapeake, VA)
    … record and other applicable hospital documentation, assigning modifiers to appropriate claims , researching edited claims for medical necessity, and ... inpatient hospitalizations, diagnostic testing, outpatient procedures and services, home health care services, durable medical equipment, rehabilitative… more
    Chesapeake Regional Healthcare (01/25/25)
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  • Pharmacy Internal Auditor

    Elevance Health (Richmond, VA)
    **Pharmacy Internal Auditor ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our ... PulsePoint locations. A proud member of the Elevance Health family of companies, CarelonRx leverages the power of new technologies and a strong, clinical-first lens,… more
    Elevance Health (01/09/25)
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  • Sr Coding Compliance Auditor

    Catholic Health Initiatives (Chattanooga, TN)
    …Coders (AAPC) as a Certified Professional Coder (CPC) required. Professional Medical Auditor Certification (CPMA) (CMAS)-preferred but not required. CRC ... **Overview** **CHI Memorial Mountain Management** CHI Memorial Medical Group (Mountain Management Services), now part of... Group (Mountain Management Services), now part of CommonSpirit Health formed between Catholic Health Initiatives (CHI)… more
    Catholic Health Initiatives (12/23/24)
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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Columbus, GA)
    …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... our PulsePoint locations. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical ...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… more
    Elevance Health (01/01/25)
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  • Diagnosis Related Group Auditor

    Hackensack Meridian Health (Hackensack, NJ)
    …as a leader of positive change. The **Diagnosis Related Group (DRG) Auditor ** is responsible for auditing clinical documentation that supports code assignment for ... includes compliance with the Conditions of Participation for CMS. The DRG auditor is responsible for ensuring coding accuracy, coding consistency and efficiency in… more
    Hackensack Meridian Health (12/06/24)
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  • Nurse Auditor /Rev Intgty Spec

    Chesapeake Regional Healthcare (Chesapeake, VA)
    … record and other applicable hospital documentation, assigning modifiers to appropriate claims , researching edited claims for medical necessity, and ... inpatient hospitalizations, diagnostic testing, outpatient procedures and services, home health care services, durable medical equipment, rehabilitative… more
    Chesapeake Regional Healthcare (01/04/25)
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  • Director of Internal Audit ( Auditor

    City of Detroit (Detroit, MI)
    …benefit package listed below. Benefits include, but are not limited to the following: HEALTH + Medical - Eligible for hospital, surgical, and prescription drug ... Director of Internal Audit ( Auditor Manager 3) Print (https://www.governmentjobs.com/careers/detroit/jobs/newprint/4745404) Apply  Director of Internal Audit (… more
    City of Detroit (01/25/25)
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  • Coding Off Auditor -Edu

    Covenant Health Inc. (Knoxville, TN)
    …and employees from other departments. Apply/Share Job Title CODING OFF AUDITOR -EDU ID 4155658 Facility Covenant Health Corporate Department Name ... Overview Inpatient Coding Auditor and Educator, Centralized Coding Full-Time, 80 Hours...Full-Time, 80 Hours per pay period, Day Shift Covenant Health Overview: Covenant Health is East Tennessee's… more
    Covenant Health Inc. (12/27/24)
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  • Auditor : Financial/TennCare

    Tennessee Comptroller of the Treasury (Nashville, TN)
    Auditor : Financial/TennCare This role focuses on examining, analyzing, and reviewing records, financial statements, claims data, and cost reports for providers ... The Comptroller of the Treasury is recruiting for a full-time Auditor : Financial/TennCare position in the Division of State Audit's Tenncare/Medicaid Section.… more
    Tennessee Comptroller of the Treasury (12/06/24)
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  • Senior Internal Auditor

    Blue Cross Blue Shield of Massachusetts (Boston, MA)
    …the Audit, Risk Management & Information Security (ARMIS) team, the Senior Internal Auditor will perform and support audits and assessments related to financial and ... to Sarbanes-Oxley), risk-based audits, and consulting engagements. The Senior Internal Auditor will participate in cross-functional projects with IT Audit, Risk… more
    Blue Cross Blue Shield of Massachusetts (01/09/25)
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  • Internal Auditor

    Sedgwick (Knoxville, TN)
    …regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than ... Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Internal Auditor **PRIMARY PURPOSE:** To perform IT internal audit procedures under general… more
    Sedgwick (11/29/24)
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  • Coding Auditor Educator

    Highmark Health (Harrisburg, PA)
    …(Outpatient): Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA) + 5 years with hospital or ... **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Performs...internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of… more
    Highmark Health (01/15/25)
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  • Senior Compliance Coding Auditor

    Nuvance Health (Danbury, CT)
    …and State guidelines. Ensure correct DRG and APC assignments for Institutional claims . 2. Maintains confidentiality of protected health information and other ... policies, ie, Center for Medicare & Medicaid Services (CMS), American Medical Association (AMA), American Health Information Management Association (AHIMA), to… more
    Nuvance Health (12/11/24)
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  • Auditor

    Health Advocates Network (Albany, NY)
    Health Advocates Network is currently seeking a ** Auditor ** to work at a facility in **Albany, New York.** These are _registry_ positions with our company. **Pay ... caregivers and advocacy groups related to prior approval of medical services such as durable medical equipment,...Sending faxes through e-mail supported fax mailbox + Supporting claims processing when other duties are finished + Maintaining… more
    Health Advocates Network (11/16/24)
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