- Premera Blue Cross (Mountlake Terrace, WA)
- …Work and Improve People's Lives** Our purpose, to improve customers' lives by making healthcare work better, is far from ordinary. And so are our employees. Working ... at Premera means you have the opportunity to drive real change by transforming healthcare . To better serve our customers, we are fostering a culture that emphasizes… more
- Elevance Health (St. Louis, MO)
- ** Claims Auditor I, II and Senior** **Location :** This role enables associates to work virtually full-time, with the exception of required in-person training ... an accommodation is granted as required by law._ The ** Claims Auditor I** is responsible for pre...related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education… more
- LA Care Health Plan (Los Angeles, CA)
- Financial Compliance Auditor III Claims Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: ... the safety net required to achieve that purpose. Job Summary The Financial Compliance Auditor III Claims is responsible for audits of claims processed… 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
- 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
- New York State Civil Service (Pearl River, NY)
- NY HELP No Agency Attorney General, Office of the Title Forensic Auditor : Investigate Complex Healthcare Fraud, 6405 Occupational Category Financial, Accounting, ... Medicaid Fraud Control Unit - Pearl River (Rockland County)Forensic Accountant/ Auditor Reference No. MFCU_PR_FAA_6405Application Deadline is October 31, 2025Salary… more
- Sharp HealthCare (San Diego, CA)
- …practices. *This is a remote position* **What You Will Do** The Compliance Coding Auditor is responsible for the administration of the Sharp HealthCare 's (SHC'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
- Bon Secours Mercy Health (Cincinnati, OH)
- …Assists in the review of Bon Secours Mercy Health coding, billing and claims processing policies and procedures for the development of compliance internal monitors ... periodic review and analysis of Bon Secours Mercy Health hospital claims denial reports, operational assessment reports, internal quality control reviews, internal… 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 (Hanover, MD)
- **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
- Elevance Health (Las Vegas, NV)
- **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, ... granted as required by law. The **Diagnosis Related Group Clinical Validation Auditor -RN** is responsible for auditing inpatient medical records to ensure clinical… more
- Idaho Division of Human Resources (Boise, ID)
- Criminal Investigator or Investigative Auditor , OAG, Criminal Law Division Posting Begin Date: 2025/10/22 Category: Criminology Sub Category: Investigative Work ... Hourly Description State of Idaho Opportunity Criminal Investigator or Investigative Auditor , Criminal Law Division, Office of the Attorney General Closing Date:… more
- Elevance Health (Hanover, MD)
- …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
- Elevance Health (Tampa, FL)
- …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 (CPC)** **Hybrid 1:** This role requires...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
- Independent Health (Buffalo, NY)
- …fosters growth, innovation and collaboration. **Overview** The Quality Assurance Auditor will perform monitoring, oversight, and quality assurance reviews/audits of ... during the quality assurance process to ensure resolution. The Quality Assurance Auditor will analyze, document, and report on results to business stakeholders and… more
- Sharp HealthCare (San Diego, CA)
- …calls in conjunction with management and Contract Reimbursement Specialist in reviewing claims processing and rejection issues that delay money collected and AR ... and resolve denied/underpaid accounts, and escalated payer trends/issues to ensure claims are processed and paid per the insurance contract.Other duties as… more
- City of New York (New York, NY)
- …obligations, regulatory 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.… more
- Bozeman Health (Bozeman, MT)
- …guidelines, payer requirements, HIPAA Privacy and Security Rules, and foundational healthcare regulations (eg, Anti‑Kickback Statute, False Claims Act, EMTALA). ... Position Summary: The Compliance Auditor supports an effective compliance program by planning and executing risk-based audits, monitoring adherence to federal and… more
- Highmark Health (Harrisburg, PA)
- …Depending on location provides or arranges for education/training of facility healthcare professionals in use of coding guidelines and practices, proper ... Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA) + 5 years with hospital or physician...skills Preferred + Associate's Degree + 3 years with claims processing and data management + Past auditing and… more
