- Molina Healthcare (Yonkers, NY)
- JOB DESCRIPTION Job Summary Provides support for claims audit activities including identification of incorrect coding, abuse and fraudulent billing practices, waste, ... overpayments, and claims processing errors. **Essential Job Duties** + Audits the...errors. **Essential Job Duties** + Audits the adjudication of claims using standard principles, and state-specific regulations to identify… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure ... claims are processed in accordance with Federal, State and...supervision. PRIMARY RESPONSIBILITIES: + Conducts monthly audits of CPHL claims utilizing CPHL guidelines, policies and procedures or any… more
- City of New York (New York, NY)
- 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. IF ... YOU ARE HIRED PROVISIONALLY AS A MANAGEMENT AUDITOR , YOU MUST TAKE AND PASS THE MANAGEMENT ...standard audit procedures examine records and documents that support claims submitted to Medicaid for reimbursement for goods or… more
- Sedgwick (Newark, NJ)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Attorney Auditor ** **This is a fully remote position, and candidates residing in any ... United States are encouraged to apply. As an Attorney Auditor at Sedgwick, you'll have the opportunity to take...other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating… more
- Elevance Health (Woodbridge, NJ)
- **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This role enables associates to work virtually full-time, ... required by law. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to...Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes… more
- City of New York (New York, NY)
- …requirements, and internal policies related to the payment of daily healthcare claims and monthly administrative fees. 2. Claims Data Validation: Verify the ... accuracy, completeness, and timeliness of daily healthcare claims payment data submitted by the health plan prior to authorize payment. Perform monthly… more
- City of New York (New York, NY)
- …is requesting to fill one (1) Clerical Associate III to function as an Expense Auditor , who will: - Audit and approve payments for staff members carfare requests. - ... stop payments of checks. - Review documentation submitted by staff to support claims and determine if information submitted is accurate. - Monitor unit mailbox and… more
- City of New York (New York, NY)
- …submit approximately 4500 payment requests annually. DDC seeks a Capital Payment Auditor to review and process these payment requisitions. To process these ... and task order registrations (in FMS3); and adjust payment voucher(s) due to liens, claims and assignments. The candidate will use the DDC automated ledger system to… more
- Lineage Logistics (Linden, NJ)
- …the plant to determine and ensure meet company standards + Report damages and claims to inventory control + Arrange stock parts in a specific order for assembly ... by other workers + Process inbound/outbound orders safely and accurately **ADDITIONAL DUTIES AND RESPONSIBILITIES** + Work with other machinery and material handling equipment **MINIMUM REQUIREMENTS (KNOWLEDGE, SKILLS, ABILITIES)** + Basic math skills +… more
- Warner Music Group (New York, NY)
- …the contractually-defined scope) of the audit concerned; + Review and analyze the audit claims submitted by the auditor in question, as well as the relevant ... including, without limitation, tracking audit notifications, reviewing and analyzing the claims contained in the audit reports we receive, making recommendations to… more
- Molina Healthcare (Yonkers, NY)
- …Healthcare claim audits including, but not limited to; vendor, focal, audit the auditor . Confirm that documentation is clear and concise to ensure accuracy in ... auditing of critical information on claims ensuring adherence to business and system requirements of...& ABILIITIES:** + Minimum 2 years as an operational auditor for at least one core operations function +… more
- Bayer (Whippany, NJ)
- …supports the following rationale for conducting customer audits: 1. **Accuracy of Claims ** : To ensure proper reimbursement and prevent revenue loss. 2. **Contracts ... laws and regulations. 4. **Error Identification** : Detect discrepancies in claims eligibility, processing, invoicing and reporting. 5. **Insights into Customer… more
- City of New York (New York, NY)
- …The role is responsible for overseeing staff responsible for the reconciling of claims payments within the City's self-funded health plan effective January 1, 2026. ... obligations, regulatory requirements, and internal policies related to health claims and monthly admin fee payments. o Oversee the...the claim associated fees. o Coordinate with the external auditor to develop and execute audit plans. o Coordinate… more
- DoorDash (New York, NY)
- …to connect messaging to downstream metrics, from comprehension to NPS to claims behavior. + Brings strong cross-functional leadership and a track record of ... 29, 2024. The Covey tool has been reviewed by an independent auditor . Results of the audit may be viewed here: Covey (https://getcovey.com/nyc-local-law-144)… 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