- LogixHealth (Dania, FL)
- Location: On-Site in Dania, FL This Role: As a Claims Specialist, you will work with internal teams to provide cutting-edge solutions that will directly improve the ... healthcare industry. You'll contribute to our fast-paced, collaborative environment...and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,… more
- Commonwealth Care Alliance (Boston, MA)
- …(must have): * 5+ years in healthcare compliance, regulatory affairs, or claims audit . * Experience working with TPA partners (eg, Cognizant) and submitting ... 011250 CCA- Claims Position Summary: Reporting to the Director, ...for ensuring CCA's operational compliance with state and federal healthcare regulations, particularly MassHealth (Massachusetts Medicaid) and CMS Medicare… more
- Guidehouse (San Marcos, CA)
- …is expected to perform all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims . Must work with other ... Billing Emphasis + Correcting and billing electronic and hardcopy claims + Submits Adjusted claims + Provides...or insurance information. + Works all rejection and payer audit reports within 48 hours of receipt taking whatever… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …of claims data and analysis, with experience working in the MD Audit tool preferred. + Knowledge of healthcare financial management principles/practices. + ... **Overview** **Be inspired. Be rewarded. Belong. At Emory Healthcare .** At Emory Healthcare we fuel...Atlanta, GA **Description** + Reporting to the Director, Compliance Audit and Analysis, oversees audits, monitoring, and education for… more
- Molina Healthcare (Sterling Heights, MI)
- **JOB DESCRIPTION** **Job Summary** Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage ... amount and benefit interpretation. Monitors and controls backlog and workflow of claims \. Oversees analysis of complex claim inquiries and reimbursement issues using… more
- Prime Healthcare (Ontario, CA)
- …improve the quality and minimize process cost of Claims for all Prime Healthcare 's self-insured Employee Health Plans. Through in-depth audit and review of ... Full Time Shift Days Connect With Us! (https://careers-primehealthcare.icims.com/jobs/196005/vp-of-health-plan-operations-and- claims /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare Management Inc… more
- LA Care Health Plan (Los Angeles, CA)
- … is responsible for various tasks within the Financial Compliance Unit, including audit of claims processed by medical groups and health plans contracted ... regulatory and contractual requirements. Communicate issues and findings that would affect the audit results. Perform claims audits for all medical groups and… more
- Elevance Health (Houston, TX)
- **External Audit Facilitator** **Location:** This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while ... a dynamic and adaptable workplace. Alternate locations may be considered. The **External Audit Facilitator** is responsible for managing the process for claims … more
- WelbeHealth (Los Angeles, CA)
- …experience may be substituted + Minimum of five (5) years of experience in healthcare claims electronic processing system + Minimum of two (2) years of ... **Plan Operation Audit Specialist** WelbeHealth is a value-based healthcare...validating various system configurations to ensure accurate processing of claims in accordance with provider agreements, regulatory guidelines, and… more
- CenterLight Health System (NY)
- …effectiveness of the claims department by timely and accurate processing of claims appeals and performing claims audit , ensuring payment integrity and ... application of transaction by our TPA. + Perform in-depth claims audit to confirm that all medical...Education: Bachelor's degree required. Experience: + 1-3 years of healthcare experience, managed care setting is strongly preferred. +… more
- LogixHealth (Dania, FL)
- …teams to provide cutting edge solutions that will directly improve the healthcare industry. You'll contribute to our fast-paced, collaborative environment and bring ... issues and appeal if necessary, using software or other resource tools + Prepare audit results and keep department manager current of all findings and audits and… more
- Providence (Renton, WA)
- …we must empower them.** **Providence St Joseph Health operates a self-administered claims program for General and Healthcare Professional Liability, Directors ... organizational metrics, and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based on trending… more
- Elevance Health (Columbus, GA)
- …billing, claims and/or customer contact automated environment (preferably in healthcare or insurance sector), or any combination of education and experience, ... **Performance Quality Analyst III ( Claims ** ) **Location** : This role requires associates...of business, multiple functions, and multiple systems. + Trend audit results and perform data analysis on trends to… more
- Novant Health (NC)
- …Employment Type: Full time with benefits What You'll Do: + The Coding Audit Response Specialist position responds to external and internal audits for INPATIENT ... the accuracy of assignment for Novant Health Facilities as assigned by Corporate Coding Audit Response Lead. + Audits will include but will not be limited to: coding… more
- Novant Health (NC)
- …Employment Type: Full time with benefits What You'll Do: + The Coding Audit Response Specialist position responds to external and internal audits for OUTPATIENT ... the accuracy of assignment for Novant Health Facilities as assigned by Corporate Coding Audit Response Lead. + Audits will include but will not be limited to: coding… more
- Commonwealth Care Alliance (Boston, MA)
- …billing-related certifications **Required Experience (must have):** + 3+ years in healthcare claims processing, provider reimbursement, or payment integrity. + ... 011250 CCA- Claims Job Description **Position Summary:** Reporting to the...claims systems (eg, Salesforce, Facets) in compliance with audit standards and MassHealth requirements. + Maintain awareness of… more
- CHS (Clearwater, FL)
- **Overview** ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical insurance ... medical audits, target audits, re-audits, etc and audits for claims which are in excess of payment authority limits...are in excess of payment authority limits in assigned audit queues. + Listen to and view all recorded… more
- Healthfirst (NY)
- …of Medicare and Medicaid programs and reimbursement methodologies a plus. + Knowledge of healthcare claims processing practices in a managed care setting a plus. ... before sign-off and Production. + Assist in the on-going audit of configurations for new and existing claims...Qualifications:** + Managed care, commercial health plan (or other healthcare related) experience where you have performed claim or… more
- Conduent (Orlando, FL)
- … Auditor CPhT** **Do you have a CPhT certification?** **Would you like to audit pharmacy claims for accuracy?** **About the Role** Conduent Payment Integrity ... performs in depth pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims ...and pharmacy practices. + Responding to pharmacy calls regarding audit results and dealing with clients periodically to report… more
- NextEra Energy (North Palm Beach, FL)
- …determine coverage and liability exposure to facilitate satisfactory settlement of claims under Miscellaneous Professional Liability (E&O), Allied Healthcare , ... **Professional Lines Claims Manager** **Date:** May 30, 2025 **Location(s):** North...post binding claim audits as needed and communicate the audit results to appropriate internal and external stakeholders. *… more