- Zenith (Sarasota, FL)
- …reviews if a contested case goes to trial. Partners with effective interaction with claims and claims legal. May involve assisting with special projects. The ... recommend payment in accordance with state fee schedules, coding guidelines, healthcare regulations and medical compliance. Monitors billing for trends. Communicates… more
- Optum (San Juan, PR)
- …. Positions in this function investigates Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following ... Reviews -75% Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim...+ CPC A Certified Inpatient Coder (CIC) Certified Outpatient Auditor (COC) Certified Professional Medical Auditor (CPMA)… more
- CHS (Clearwater, FL)
- **Overview** ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical ... and procedures. + Reviews Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) to determine proper...and lifting up to thirty (30) pounds. ** ** ** Claims and Call Auditor (Call Center QC)… more
- NTT DATA North America (Decatur, IL)
- …when executed as part of an overall sourcing strategy. NTT DATA currently seeks a Claims Auditor to join our team for a remote position. 100% Remote, Client ... of Direct Hire Pay Rate $21-$22/hr **Position Summary:** The Claims Auditor position reports to the Chief...High School Education. + Minimum 3 years' experience in Healthcare Claims Processing role + Minimum 1… more
- Conduent (Alexandria, VA)
- …audits on behalf of major healthcare payers. As a **Pharmacist - Claims Auditor /Reviewer** , you'll apply your clinical knowledge and regulatory expertise to ... where individuality is noticed and valued every day. **Pharmacist - Claims Auditor /Reviewer (Part-Time)** **Conduent Payment Integrity Solutions** **Are you… more
- Conduent (Los Angeles, CA)
- …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 ... of a culture where individuality is noticed and valued every day. **Pharmacy Claims Auditor CPhT** **Do you have a CPhT certification?** **Would you like to… more
- Insight Global (Los Angeles, CA)
- …skills Ability to work independently and collaboratively In-depth knowledge of healthcare regulations and claims processing systems Reliable transportation for ... Insight Global is looking for a Sr. Financial Compliance Auditor for one of the largest health systems in...person will be responsible for for conducting audits of claims processed by medical groups and health plans contracted… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … more
- Amergis (Los Angeles, CA)
- …is dependent on employment status. About Amergis Amergis, formerly known as Maxim Healthcare Staffing, has served our clients and communities by connecting people to ... since 1988. We provide meaningful opportunities to our extensive network of healthcare and school-based professionals, ready to work in any hospital, government… more
- Sharp HealthCare (San Diego, CA)
- …position, and employer business practices. **What You Will Do** The Compliance Coding Auditor is responsible for the administration of the Sharp HealthCare 's ... and procedures. The position plays a key role in oversight of Sharp HealthCare 's (SHC) compliance audit function and maintaining Sharp HealthCare 's view of… more
- Planned Parenthood of Central and Western NY (Rochester, NY)
- Billing Auditor for Shared Services Fully Remote * Rochester, Buffalo, or Syracuse, NY * Revenue Cycle Description Billing Auditor for Shared ServicesBuffalo, ... of PPCWNY's mission and the collaboration with Shared Services, the Billing Auditor evaluates Revenue Cycle outcomes to identify and recommend opportunities for… more
- Humana (Montgomery, AL)
- …Coding Quality Team is looking is an experienced and well-grounded medical coding auditor to quality review the inpatient hospital claims for proper ... this role, you will conduct quality reviews of coding processes within the Claims Cost Management organization, including offshore and vendor partners, with a focus… more
- Elevance Health (Grand Prairie, TX)
- **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ __ _This role enables associates to work virtually full-time, with the exception of required in-person training ... recover, eliminate and prevent unnecessary medical-expense spending. The **DRG CODING AUDITOR ** is responsible for auditing inpatient medical records and generating… more
- UPMC (Pittsburgh, PA)
- **Join UPMC Corporate Compliance as an Intermediate Compliance Auditor !** Are you passionate about ensuring accuracy and compliance in healthcare documentation ... **UPMC Corporate Compliance** is seeking a dedicated and detail-oriented **Intermediate Compliance Auditor ** to join our team! This position will be based out of… more
- Elevance Health (Seattle, WA)
- **Diagnosis Related Group Clinical Validation Auditor -RN** **Virtual:** This role enables associates to work virtually full-time, with the exception of required ... Friday 8AM -5PM (local time) The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to ensure clinical… more
- Elevance Health (Grand Prairie, TX)
- …systems/tools to accurately document determinations and continue to next step in the claims lifecycle. + Researches new healthcare related questions as necessary ... **Clinical Provider Auditor II** **Supports the Payment Integrity line of...abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines… more
- UPMC (Pittsburgh, PA)
- **Join UPMC Corporate Finance as a Compliance Auditor , Associate!** Are you detail-oriented and passionate about ensuring compliance in healthcare ? **UPMC ... Corporate Finance** is looking for a dedicated and meticulous **Compliance Auditor , Associate** to join our team. This role is crucial in maintaining the integrity… more
- Elevance Health (Indianapolis, IN)
- **Provider Auditor ** **Location** : Indianapolis, IN **Field:** This field-based role enables associates to primarily operate in the field, traveling to client sites ... unless an accommodation is granted as required by law._ The **Provider Auditor ** conducts on-site reviews of medical charts, medical notes, itemized bills and… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Inpatient Coding Auditor and Educator, Centralized Coding Full-Time, 80 Hours per pay period, Day Shift Covenant Health Overview: Covenant Health is East ... Tennessee's top-performing healthcare network with 10 hospitals (http://www.covenanthealth.com/hospitals/) and over 85...+ Reviews information from third party payers relative to claims charging, coding, and billing in order to ensure… more
- Amentum (Albany, NY)
- …research on individuals, business entities, and assets. + Analyze large and complex healthcare claims datasets to identify fraud, waste, and abuse patterns. + ... trends and patterns. + Extract and manipulate federal health claims data using CMS tools such as OnePI, STARS,...briefings and written reports to AUSAs on findings from healthcare data analytics. + Support development of internal best… more
