- Conduent (Newark, NJ)
- …be part of a culture where individuality is noticed and valued every day. **Pharmacy Claims Auditor CPhT** **Do you have a CPhT certification?** **Would you like ... pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety of pharmacy records against our… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Claims Auditor 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #1153 Monday, December 2, 2024 Centers Plan for Healthy Living's goal is to create the ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … more
- ManpowerGroup (New York, NY)
- Jefferson Wells is seeking an experienced **Insurance Auditor with Life Claims ** expertise to join our team. The successful candidate will be responsible for ... compliance with company policies, industry standards, and regulatory requirements. The auditor will analyze the claims documentation and processes, identify… more
- City of New York (New York, NY)
- …As such, DCAS/Audit and Compliance Services seeks to hire a Vendor Contract Auditor to coordinate, monitor and conduct reviews of audit work performed by contracted ... master contracts under the purview of a Senior Staff Auditor /Supervisor and the Audit Director. Responsibilities for the Internal...of vendor contract and/or financial auditing, and auditing of claims for payment to assess their validity on a… more
- Elevance Health (Woodbridge, NJ)
- **Diagnosis Related Group Clinical Validation Auditor -RN** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live ... one of our PulsePoint locations. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to ensure clinical… more
- City of New York (New York, NY)
- …to ACS' Senior leadership, auditees and stakeholders. Responsibilities for the Lead Auditor /Supervisor will include but may not be limited to: - Plan, coordinate ... with vendor contract and/or financial auditing, and auditing of claims for payment to assess their validity on a...Accountant License or a certificate as a Certified Internal Auditor and four years of full-time experience as indicated… more
- Highmark Health (Trenton, NJ)
- …Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA) + 5 years with hospital or physician coding and/or ... and communication skills Preferred + Associate's Degree + 3 years with claims processing and data management + Past auditing and strong education/training background… more
- City of New York (New York, NY)
- …reports. - Participates in and reviews the processing of fiscal documents, claims , financial statements, and the accounting for the receipt, deposit and disbursement ... of large sums of money. - Performs work using information available in various phases of the accounting systems, account relationships and established techniques for computing and verifying accounting data. - Examines, analyzes, reconciles, adjusts and… more
- City of New York (New York, NY)
- …relating to cost allocation. The Finance Office is recruiting for one (1) Management Auditor II to function as an Administrative Claims Preparer who will: - ... Job Description APPLICANTS MUST BE PERMANENT IN THE MANAGEMENT AUDITOR CIVIL SERVICE TITLE, OR BE PERMANENT IN A...COMPARABLE TITLE ELIGIBLE FOR 6.1.9 TITLE CHANGE Bureau of Claims and Reimbursement (BCR) is responsible for the daily… more
- City of New York (New York, NY)
- …ARE PERMANENT (NOT PROVISIONAL) IN THE CIVIL SERVICE TITLE OF MANAGEMENT AUDITOR . The Administration for Children's Services (ACS) protects and promotes the safety ... The work of DFS includes managing the ACS budget; submission of monthly claims for revenue; processing of payments to provider agencies and vendors; monitoring the… more
- Elevance Health (Woodbridge, NJ)
- …controls. **How you will make an impact:** + Detailed pharmacy claims validation + Interpreting and managing audit requirements, ie, timelines, internal/external ... and presenting audit status summaries to internal/external stakeholders + Analyzing auditor results and communications + Identifies, monitors, revises, and tracks… more
- Terumo Medical Corporation (Somerset, NJ)
- …business partners. + Extensive knowledge of laws (FD&CA, Anti-kickback Statute, False Claims Act, Foreign Corrupt Practices Act, HIPAA, Sunshine Act, and State ... education and prior work experience. Certified Public Accountant, Certified Internal Auditor , and/or Compliance Certification a strong plus. + Strong experience with… more
- Amazon (New York, NY)
- …ongoing financial and risk analysis. -Support ongoing actuarial support for outside auditor review of financial estimates and results. -Design studies to monitor the ... of actuarial reserving, forecasting and medical economics -Expertise in working with medical claims data and using programming languages such as SQL, R, SAS, Python,… more
- Sedgwick (New York, NY)
- …and procedures are implemented and followed to achieve efficient operations and meet auditor requirements. + Acts as a resource and emissary for clients through ... their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more… more
- CVS Health (Trenton, NJ)
- …detection, investigation, or auditing In-depth knowledge of healthcare systems, claims processing, and regulatory requirements related to healthcare fraud. ... Certification - Certified Professional Biller (CPB), Certified Professional Medical Auditor (CPMA), Certified Outpatient Coder (COC), Certified Risk Adjustment Coder… more