- vaco (White Plains, NY)
- …of reinsurance contracts, ensuring accuracy in remittance, premium payments, and claims billing. Reports to the Chief Underwriting Officer, P&C Americas.Key ... risk and premium to the companyValidate premium payments, including adjustmentsLiaise with claims to verify billing accuracyDevelop and execute an audit plan; report… more
- Monster (Findlay, OH)
- …support optimal and accurate charge processes; collaborate with CDI Specialist, Claims Resolution Specialist, Revenue Integrity Auditor , Revenue Integrity ... with appropriate resources, as needed, to resolve. Duty 2:Support resolution of claim -scrubber edits (Quadax) resulting from charges entered by the Revenue Integrity… more
- vaco (Villa Park, CA)
- …on the Insurance Accounting team, your understanding of the policy/billing and claims instances of Guidewire and ability to perform related user acceptance testing ... business units.Gain and apply understanding of Guidewire insurance policy, billing, and claims systems. Other systems include HUON and Policy Star.Gain and apply… more
- HCA Healthcare (Nashville, TN)
- …purpose and integrity. We care like family! Jump-start your career as a Managed Care Claims Auditor today with Work from Home. **Benefits** Work from Home offers ... for benefits may vary by location._** Come join our team as a Managed Care Claims Auditor . We care for our community! Just last year, HCA Healthcare and… more
- Conduent (Los Angeles, CA)
- …a culture where individuality is noticed and valued every day. **Pharmacy Claims Auditor CPhT** **Do you have a CPhT certification ?** **Would you like to ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a...claim data. This is to ensure billed pharmacy claims are being accurately submitted. You will also be… more
- Commonwealth of Pennsylvania (PA)
- Auditor 1 Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5057089) Apply Auditor 1 Salary $51,971.00 - $79,062.00 Annually Location *Home ... Audits, Liquor Control Board Operations is looking for an Auditor 1 to become part of a culture that...attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements.… more
- Prime Therapeutics (San Diego, CA)
- …and drives every decision we make. **Job Posting Title** Onsite Pharmacy Auditor (based in Southern 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
- Actalent (West Des Moines, IA)
- …understanding of standard medical coding, including CPT, ICD-10, and HCPCS. The Nurse Auditor is responsible for adjudicating claims to comply with client ... Nurse Auditor Job Description This role requires a thorough...claims , auditing and pricing a wide variety of claim types, and ensuring compliance with departmental and company… more
- System One (Lakewood, NJ)
- …manufacturing environment, ideally with polymers. + ISO 9001:2015 experience required; ISO Lead Auditor certification a plus. + Knowledge of quality tools (eg, ... essential to maintaining the Company's reputation for quality, supporting ISO certification , and driving ongoing improvement, and consistently in the Company's… more
- Elevance Health (Richmond, VA)
- …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...auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all… more
- ManpowerGroup (Vienna, VA)
- …of life insurance products + In-depth knowledge of life insurance products, claims processes, and regulatory compliance requirements. + Certification in ... seeking a Bank and Corporate Owned Life Insurance (BOLI/COLI) Auditor to join their team. As a Bank and...policies. + Conduct thorough audits of life and death claims to verify accuracy, completeness, and compliance with company… more
- US Pacific Fleet (San Diego, CA)
- …You will be required to obtain and maintain a current ISO 9000:2008 Internal Auditor certification . + You will be required to wear personal protective equipment ... when selecting individuals under this specific hiring authority. However, if you claim veteran's preference, you will be required to submit supporting documentation… 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
- Insight Global (South Jordan, UT)
- …valid claim identification and documentation (letter writing). Identifies potential claims outside of the concept where additional recoveries may be available. ... Job Description Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100%...for auditing inpatient medical records and generating high-quality recoverable claims for the benefit of our client and their… more
- Elevance Health (Mason, OH)
- **Clinical Provider Auditor II** **Location:** _Hybrid1:_ This role requires associates be in the office 1-2 days per week, fostering collaboration and connectivity, ... is granted as required by law. The **Clinical Provider Auditor II** is responsible for identifying issues and/or entities...abuse. **How you will make an Impact:** + Examines claims for compliance with relevant billing and processing guidelines… more
- Elevance Health (Des Moines, IA)
- **Clinical Provider Auditor II** **Supports the Payment Integrity line of business** **Hybrid 1** : This role requires associates to be in-office **1-2** days per ... recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Provider Auditor II** is responsible for identifying issues and/or entities that… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The Network Provider Services Auditor performs audits as part of the Documentation and Coding Compliance Program for ... medical record documentation for completeness and accuracy to support billed claims . + Generate provider reports through billing software. + Coordinates, schedules,… more
- Atlantic Health System (Morristown, NJ)
- …+ Follows up with providers as needed until documentation improves + Assists with claim denial reports to ensure optimal reimbursement + Serves as a resource to the ... department + Provides clarification on coding and compliance policies Required: * CPC Certification * Minimum 6 months experience in similar role highly preferred *… more
- Commonwealth Care Alliance (Boston, MA)
- … claims management, coding rules and guidelines, and evaluating/analyzing claim outcome results for accurate industry standard coding logic and policies ... 011250 CCA- Claims Hiring for One Year Term **_This position...to have the one or all of the required certification OR willing to get certified within 1 year… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Claim and Denial Coding Analyst role is a Certified Medical Coder who ensures clean ... claim submission and timely review and resolution of coding... Editing Manager, Physician, Specialty Coder, AR specialist or Auditor /Educator. Demonstrate the ability to formulate an appeal rationale… more
