- 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 ... and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,...two years related experience + Healthcare industry knowledge + Medical billing experience Benefits at LogixHealth: We offer a… more
- LA Care Health Plan (Los Angeles, CA)
- … Claims is responsible for various tasks within the Financial Compliance Unit, including audit of claims processed by medical groups and health plans ... contractual requirements. Communicate issues and findings that would affect the audit results. Perform claims audits for all medical groups and health plans… more
- CenterLight Health System (NY)
- …monies and proper application of transaction by our TPA. + Perform in-depth claims audit to confirm that all medical claims paid and denied accurately. ... claims department by timely and accurate processing of claims appeals and performing claims audit...enhance claim workflow and efficiency. + Analyze patient and medical information to identify Coordination of Benefits (COB), Worker's… 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
- 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 ... any and all related job duties as assigned. **_The medical biller will be working a Hybrid schedule based...Billing Emphasis + Correcting and billing electronic and hardcopy claims + Submits Adjusted claims + Provides… more
- WelbeHealth (Los Angeles, CA)
- **Plan Operation Audit Specialist** WelbeHealth is a value-based healthcare organization that's transforming the future of senior care by providing an all-inclusive ... the healthcare and social services needed to thrive. The Plan Operations Audit Specialist will be accountable for validating various system configurations to ensure… more
- LA Care Health Plan (Los Angeles, CA)
- …Summary The Specialty Plans Auditor III is responsible for planning audits and audit work programs that address appropriate claims and financial compliance ... Senior Health Care Audit Analyst Job Category: Accounting/Finance Department: Financial Compliance...also LA Care contractual agreements. The position handles DMHC claims data submissions for LA Care and its Plan… more
- Kelly Services (Glastonbury, CT)
- **Job Title:** Medical Claims Processor / Medical Claims Specialist **Pay Rate:** $23.00/hour **Schedule:** 11:30 AM - 8:00 PM or 8:30 AM-5:00 PM ... We are currently seeking a detail-oriented, organized, and compassionate ** Medical Claims Processor / Medical ...accurate financial records and assist with batch processing + Audit outgoing payments for accuracy and compliance + Manage… more
- Houston Methodist (Houston, TX)
- …and capture potential revenue opportunities. This position performs quality assurance, detailed claims analysis and medical record reviews of complex claims ... FUNCTIONS** + Conducts risk-based and baseline reviews of complex and escalated claims or records in a timely manner, evaluates corrective actions and processes… more
- Conduent (Warren, MI)
- …and be part of a culture where individuality is noticed and valued every day. ** Claims Auditor** **Position is onsite in Warren, MI** Training: Mon- Thur ( On the ... North America Supplier Claim Activity ("SCA") group is responsible for receipt, audit , processing, accrual and forecasting of supplier obsolescence and cancellation … more
- CHS (Clearwater, FL)
- … claims administration, is where submissions for payment/reimbursement/sharing from medical providers and covered individuals are reviewed, subject to cost ... **Overview** ** Claims Manager** **Servicing** **Health Insurance Policies or Benefits**...Examiner queues waiting to be adjudicated, and in either audit or needing approval status. * Developing and implementing… more
- Providence (Renton, WA)
- …organizational metrics, and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based on trending ... leaders for claims management improvement opportunities and claims -related trends through audit , data analytics, and...Insurance terminology + Legal concepts + Liens + Electronic claims databases + Medical terminology **Skills required… more
- Robert Half Accountemps (Minneapolis, MN)
- …Process appeals and adjustments in alignment with established procedures and guidelines. * Audit claims for accuracy and adherence to organizational standards. * ... role at a MCO (Managed Care Organization). * Proven experience in medical claims analysis, preferably within a managed care organization or healthcare setting. *… 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
- CHS (Clearwater, FL)
- … and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical insurance claims and customer ... Duties and Responsibilities:** + In accordance with company guidelines, performs random medical audits, target audits, re-audits, etc and audits for claims … 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 ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety...and pharmacy practices. + Responding to pharmacy calls regarding audit results and dealing with clients periodically to report… more
- Molina Healthcare (Sterling Heights, MI)
- …and improvements. + Provides oversight of research and analytics associated with medical claims processing requirements (1500 and UB04), provider and benefit ... **JOB DESCRIPTION** **Job Summary** Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage… more
- Old Dominion Freight Line (Thomasville, NC)
- …pay as needed + Review financial information and determining settlement of downtime claims + Audit and process independent adjuster invoices + Write settlement, ... keep OD the premier transportation solutions provider. Effectively handle property damage claims due to OD vehicle accidents and incidents. Perform other duties… more
- Public Storage (Plano, TX)
- …workers' compensation matters + Interface with employees, managers, insurance carriers, medical personnel and attorneys regarding workers' compensation claims , ... and compliance with state filing requirements + Oversee medical utilization + Review and analyze all claims...resolution + Assist in developing systems to track, monitor, audit and prepare reports regarding workers compensation + Interpret… more
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