- 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: ... to achieve that purpose. Job Summary The Financial Compliance Auditor III Claims is responsible for various...Manager of Financial Compliance. These assignments may include claims data reporting in the Online Monitor Tool (OMT),… more
- LA Care Health Plan (Los Angeles, CA)
- Specialty Health Plans Claims Auditor III Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: ... to achieve that purpose. Job Summary The Specialty Plans Auditor III is responsible for planning audits and audit...Groups (PPG), Specialty Health Plans (SHP) and Pharmacy Benefit Manager (PBM) including LA Care's Claims Department.… more
- Elevance Health (Tampa, FL)
- …claim identification, and documentation purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside of the concept ... **DRG CODING AUDITOR ** **Location** : _This position will work virtually._...auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all… more
- Trinity Health (Syracuse, NY)
- …payment models. . Identify coding discrepancies and work with risk adjustment auditor / manager to communicate deficiencies to providers. Core Values: . Reverence: ... diagnoses assigned in the EHR by the providers to claims being submitted for their services. Using billing system...support addressing HCC codes for Risk Adjustment before a claim is submitted to payers. . Demonstrate a solid… more
- Elevance Health (Independence, OH)
- …using medical charts, medical notes, and provider contracts. + Verifies dollar amount on claim is correct in claims system and writes report of the findings ... **Provider Auditor ** _This position will work a hybrid model...itemized bills and providers contracts to ensure that a claim is paid in accordance with the contract, provider… more
- UPMC (Pittsburgh, PA)
- …Care departments related to audit processes and results. The Clinical FWA Auditor /Analyst utilizes claims analysis, document review and applies FWA detection ... Health Plan has an exciting opportunity for a Clinical Auditor /Analyst position in the CCBH Fraud, Waste & Abuse...Investigations Unit (SIU). This position reports directly to a Manager , FWA, with oversight by the Senior Director and… more
- The County of Los Angeles (Los Angeles, CA)
- LAW ENFORCEMENT AUDITOR Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4668332) Apply LAW ENFORCEMENT AUDITOR Salary $109,807.68 - ... law enforcement operations. This classification acts as a project manager and is distinguished by its role in providing...No 10 In the execution of the Law Enforcement Auditor duties, you will have to make site visits… more
- Saint-Gobain (Jonesburg, MO)
- …Production + Member of American Society of Quality + ASQ Certificate as Engineer, Auditor , or Manager + Ability to develop and implement quality programs, ... ensure finished goods conform to specified requirements. + Manages the customer claims resolution and corrective action system. + Creates local documentation, such… more
- Catholic Health Initiatives (Chattanooga, TN)
- …with us today! **Responsibilities** **Job Summary / Purpose** The Sr Coding Compliance Auditor is responsible for reviewing chart notes for proper coding with an ... met at the highest level. The Sr Coding Compliance Auditor 's primary focus will be to facilitate and ensure...other portion of time focused on provider communication, and claims denial resolutions. Communicates denial trends to leadership and… more
- Elevance Health (Norfolk, VA)
- **Diagnosis Related Group Clinical Validation Auditor -RN** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live ... one of our PulsePoint locations. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to ensure clinical… more
- Boar's Head Brand/Frank Brunckhorst Co., LLC (Sarasota, FL)
- …Boars Head Brand. Complete special projects as assigned by the Sr. QA Manager . Job Description: Essential Duties and Responsibilities + Provide advanced super user ... COAs, Allergen forms, Weight & Tare, any other product claims , etc.), as applicable. + Perform Food Safety &...able to attend a training course. + Serve Safe Manager Certification or be able to attend a training… more
- Elevance Health (Columbus, OH)
- **Clinical Provider Auditor II** **Supports the Payment Integrity line of business** _Location:_ Alternate locations may be considered. This position will work in a ... recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Provider Auditor II** is responsible for identifying issues and/or entities that… more
- Elevance Health (South Portland, ME)
- **Clinical Provider Auditor II** _Alternate locations may be considered. This position will work a hybrid model (remote and office). The ideal candidate will live ... recover, eliminate and prevent unnecessary medical-expense spending. The Clinical Provider Auditor II is responsible for identifying issues and/or entities that may… more
- US Capitol Police (Washington, DC)
- …laws, economy, and efficiency and/or achievement of program results; and (b) selected claims , costs, cost proposals, and cost and pricing data arising from loans or ... audits or participates as a team member of audits led by a higher-graded auditor . The audits conducted may involve financial records and systems or consist of… more
- Highmark Health (Columbus, OH)
- …and ensures compliance with DRG/APC structure and regulatory requirements. Performs periodic claim form reviews to check code transfer accuracy from the abstracting ... and research related to special projects and providing coverage for coding manager (s). (10%) + Depending on location provides or arranges for education/training of… more
- Boar's Head Brand/Frank Brunckhorst Co., LLC (Brooklyn, NY)
- …you will assist with special projects as directed by the Senior QA Manager . Job Description: Essential Duties and Responsibilities + Conduct Food Safety and Product ... product specifications, allergen forms, weight and tare information, and other product claims , as applicable. + Maintain accurate supplier information in the QMS… more
- Axis (New York, NY)
- …request for candidates taking part in the selection process. **Sarbanes Oxley (SOX) Auditor ** **How does this role contribute to our collective success?** The SOX ... auditor will assist in delivering the annual SOX project...variety of stakeholders across the business such as Finance, Claims , Operations, Reserving and Risk Funding. This role will… more
- CareOregon (Portland, OR)
- …for remote positions must reside in Oregon or Washington. Job Title Coding Auditor Requisition # 24856 Exemption Status Exempt Management Level n/a Direct Reports ... n/a Manager Title Director Risk Adjustment Department Finance Pay and...in Oregon or SW Washington. Job Summary The Coding Auditor performs code audits and is responsible for chart… more
- Robert Half Office Team (Los Angeles, CA)
- Description We are actively seeking an Entry Level Auditor to join our team based in Los Angeles, California. In this role, you will play a crucial part in ... with our collection and schedule policy * Resolve disputed claims with signatory companies or members promptly and respectfully...Collaborate with other auditors as requested by the assistant manager or manager * Prepare and write… more
- AIG (Charlotte, NC)
- …Policies (GPO), Domain Name Services (DNS), and multiple Quest products, such as Change Auditor and Recovery Manager . In this role, you will be responsible for ... supporting and implementing Active Directory security related products, such as Quest Change Auditor , Enterprise Reporter and Recovery Manager , or similar + 4+… more