- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Working under the direction of the Sr . Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr . Analyst will ... **Essential Duties & Responsibilities:** + Develop enhanced, customized prospective claims auditing and clinical coding and reimbursement policies and necessary… more
- Fallon Health (Worcester, MA)
- …Committee and plays a key role in auditing risks identified in the organization. The Senior Internal Auditor plays a key role in implementing the annual audit ... plan. The Senior Internal Auditor conducts audits and related...insurance industry. + At least one-year experience in a Sr . Auditor capacity. + Information Technology auditing… more
- 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....expenses. "Good people beget good people."- Dr. Thomas Frist, Sr . HCA Healthcare Co-Founder We are a… more
- Elevance Health (Houston, TX)
- **Clinical Provider Auditor Senior ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one ... of our PulsePoint locations. The **Clinical Provider Auditor Sr ** will be responsible for identifying...abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- Summary With direction from the Patient Financial Services Director, the Nurse Auditor / Revenue Integrity/ CDM Analyst is responsible for performing audits of ... record and other applicable hospital documentation, assigning modifiers to appropriate claims , researching edited claims for medical necessity, and advising… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …member of the Audit, Risk Management & Information Security (ARMIS) team, the Senior Internal Auditor will perform and support audits and assessments related ... Ready to help us transform healthcare ? Bring your true colors to blue. We...(similar to Sarbanes-Oxley), risk-based audits, and consulting engagements. The Senior Internal Auditor will participate in cross-functional… more
- Elevance Health (MD)
- **Clinical Provider Auditor Senior - Maryland Behavioral Health** **Supports Payment Integrity & Behavioral Health** _Location: This position will work a hybrid ... to improve the delivery of care. The **Clinical Provider Auditor Senior ** is responsible for identifying issues...document determinations and continue to next step in the claims lifecycle. + Researches new healthcare related… more
- Nuvance Health (Danbury, CT)
- …Special Associate Compliance Officer (SACO) Physician Audit & Billing, the Senior Inpatient Professional Auditor providesHospital Inpatient and Outpatient ... and State guidelines. Ensure correct DRG and APC assignments for Institutional claims . 2. Maintains confidentiality of protected health information and other forms… more
- DoorDash (San Francisco, CA)
- …structuring of insurance programs. In this role, you will report to the Senior Manager, Actuary. You're excited about this opportunity because you will + Lead ... developing and analyzing key claims and telematics metrics that drive business decisions on...must + Strong communication skills. Experience with presenting to senior leadership is a plus. + Work experience in… more
- Somatus (Mclean, VA)
- …grow, and be the best version of themselves, including: + Subsidized, personal healthcare coverage (medical, dental vision) + Flexible Paid Time Off (PTO) + ... relevant actuarial estimates. Leads the development/compilation of the risk premium, claims and shared savings forecasting models used in the corporate… more
- DoorDash (Tempe, AZ)
- …enjoy building a dynamic, fast-moving Legal Compliance function. You will report to the Senior Manager of Legal Operations on our Legal Operations team in our Legal ... You're excited about this opportunity because you will + Work with the Senior Legal Operations Manager, Litigation, and Privacy counsel to shape the vision and… more
- UNUM (Chattanooga, TN)
- …and enhancing your professional skills + Gain exposure to networking opportunities with senior leader across our enterprise locations + Take part in social events, ... offers and compensation incentives + Provided competitor intelligence around available claims reporting for insurance and service products + Created new hire… more
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