- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …required Master's degree in a related field from an accredited institution preferred Certified Internal Auditor (CIA), Certified Health Care Compliance (CHC), ... pivot from a "job" opportunity to an authentic experience! The Lead Compliance Auditor leads comprehensive audits and conducts key activities of the IEHP Compliance… more
- Insight Global (Los Angeles, CA)
- Insight Global is looking for a Sr. Financial Compliance Auditor for one of the largest health systems in the country. This person will be responsible for for ... conducting audits of claims processed by medical groups and health plans contracted with LA Care, focusing on regulatory and contractual compliance across Medi-Cal,… more
- Solugenix (Los Angeles, CA)
- Financial Compliance Auditor III, Claims Los Angeles, CA (Remote) 3-Month Contract Job ID 25-09703 Solugenix is assisting a client, a health insurance company, ... in their search for a Financial Compliance Auditor III, Claims . This is a 3-month...This position is responsible for all aspects of assigned claim audits, including audit testing and completion of the… more
- St. Luke's University Health Network (Allentown, PA)
- …The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all diagnosis and procedure codes to assure ... determination made by the government or commercial payors, or their auditor representative. Facilitate clinical chart reviews to assist with supporting assigned… more
- Lucky Vitamin (Bloomingdale, IL)
- …OSHA ready. Partners with HR Business Partners to manage work compensation claims . Partners with recruiting on pre-employment functional testing to ensure new ... regulations. Proficient with electronic documentation management system software is preferred . Excellent written and verbal communication skills. Ability to write… more
- Berkley (Manassas, VA)
- …Be a highly effective user of all financial systems, policy and claims systems, and corporate platforms and tools. Identify and coordinate the resolution ... for all compliance requests, including Financial SOX control testing and auditor requests, ensuring an efficient process and timely completion. Team Development:… more
- Boar's Head Brand/Frank Brunckhorst Co., LLC (Sarasota, FL)
- …a training course. + SQF or any other GFSI Scheme certification desired. + Auditor Certification preferred (ie American Society for Quality - Certified HACCP ... COAs, Allergen forms, Weight & Tare, any other product claims , etc.), as applicable. + Perform Food Safety &...Auditor , Certified Quality Auditor , Certified Supplier Quality… more
- Prime Therapeutics (Denver, CO)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Pharmacy Claims Auditor - Remote **Job Description** The Pharmacy Claims ... Auditor is responsible for the selection and auditing of claims , educating Prime's network pharmacies and driving contract compliance, and supporting downstream … more
- CHS (Clearwater, FL)
- **Overview** ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical ... work independently **Qualifications** **Qualifications:** + Prior auditing experience is preferred + Knowledge of medical terminology + Knowledge of...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... Processing role + Minimum 1 year experience in claims auditing. ** PREFERRED EXPERIENCE:** Communicate in a… more
- Insight Global (Los Angeles, CA)
- Job Description Insight Global is looking for a Sr. Financial Compliance Auditor for one of the largest health systems in the country. This person will be ... responsible for for conducting audits of claims processed by medical groups and health plans contracted with LA Care, focusing on regulatory and contractual… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …experience Preferred : Type of Experience Required: 2+ years of claim processing experience with a Medicaid/Medicare Health Plan. Preferred : Experience ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … 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
- Prime Therapeutics (San Diego, CA)
- …passion and drives every decision we make. **Job Posting Title** Onsite Pharmacy Auditor (based in California) **Job Description** The Onsite Pharmacy Auditor ... pharmacy audits and is responsible for the selection and auditing of claims , educating Prime's network pharmacies and driving contract compliance, and supporting… more
- UIC Government Services and the Bowhead Family of Companies (Plano, TX)
- …as a Quality Assurance Manager in a manufacturing setting + A Certified Aerospace Auditor certification is preferred + Qualified candidates must be an ASQ ... Certified Manager of Quality/OE, Certified Quality Auditor or a Certified Quality Inspector + Experience with...characteristics EOE/D/V. In furtherance, pursuant to The Alaska Native Claims Settlement Act 43 USC Sec. 1601 et seq.,… more
- Elevance Health (Grand Prairie, TX)
- …claim identification, and documentation purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside of the concept ... **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ __ _This...Audit setting or hospital coding or quality assurance environment preferred . + Broad knowledge of medical claims … more
- LA Care Health Plan (Los Angeles, CA)
- Specialty Health Plans Auditor III Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... net required to achieve that purpose. Job Summary The Specialty Health Plans Auditor III is responsible all aspects of planning, execution, reporting and corrective… more
- Henry Ford Health System (Troy, MI)
- …SUMMARY: Reporting to the Manager, Revenue Integrity, the Revenue Integrity Auditor must have a comprehensive understanding of medical terminology, coding, charge ... entry, and healthcare revenue cycle processes. The Revenue Integrity (RI) Auditor provides support for timely, accurate and inclusive charge capture, coding, billing… 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
- UPMC (Pittsburgh, PA)
- **Join UPMC Corporate Compliance as an Intermediate Compliance Auditor !** Are you passionate about ensuring accuracy and compliance in healthcare documentation and ... **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
