- Conduent (Orlando, FL)
- …and be part of a culture where individuality is noticed and valued every day. ** Pharmacy Claims Auditor CPhT** **Do you have a CPhT certification?** **Would ... 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 … more
- 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 ... and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care. The ** Pharmacy Internal Auditor...processes and processes related to enrollment and billing and claims processing, as well as customer service written and… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …services, home health care services, durable medical equipment, rehabilitative therapies, and pharmacy reviews from finance and/or claims department + Prepare ... Summary With direction from the Patient Financial Services Director, the Nurse Auditor / Revenue Integrity/ CDM Analyst is responsible for performing audits of… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …services, home health care services, durable medical equipment, rehabilitative therapies, and pharmacy reviews from finance and/or claims department . Prepare ... Job Summary With direction from the Director, the Nurse Auditor /Revenue Integrity Specialist is responsible for auditing itemized charges versus the patient medical… more
- AmeriHealth Caritas (Philadelphia, PA)
- …integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. ... communicate the audit outcome to the appropriate persons. The auditor will validate production to ensure that the case...will be expected to build/run complex queries to identify claims affected by the configuration change and analyze all… more
- Health Advocates Network (Coral Springs, FL)
- …! This is a full-time contract position at a nationally recognized independent pharmacy / DME company located in **Coral Springs, FL.** + **Pay Rate: $20.00 per ... group of clinicians to ensure the documentation is clinically sufficient before claims are submitted to insurance companies for payment. Prioritize workloads to… more
- The Cigna Group (Seattle, WA)
- …contractual requirements. **ESSENTIAL FUNCTIONS** + Perform efficient and effective network pharmacy claims audits to produce results consistent with ... professional input to complex Quality Assurance/Audit assignments/projects to identify pharmacy audit risks. Works autonomously, only requiring "expert" level… more
- BD (Becton, Dickinson and Company) (San Diego, CA)
- …nonconforming products with a focus on minimizing Escape incidents. + Oversee intracompany claims and drive the resolution process. + Conduct and manage QMS Audits, ... promptly. + Lead investigations into deviations, non-conformances, and customer claims . + Ensure accurate traceability of products throughout the distribution… more