- Robert Half Accountemps (Boston, MA)
- Description Job Title: Medical Claims Auditor - RN Auditor Location: Massachusetts - 90% Remote Job Type: 1 Year Contract - Potential for Perm Hire ... 1, 2025 Job Description We are seeking a qualified Auditor with healthcare experience to support Program Integrity activities...perform onsite audits (1-4 times per month) + Evaluate claims and provider documentation for compliance and accuracy +… more
- Cognizant (Boston, MA)
- ** Claims Auditor ** (remote) This is a remote position open to any qualified applicant that lives in the United States. **Summary:** Our Cognizant leadership ... to perform the following duties and work as part of our established claims adjudication team. We are seeking highly motivated healthcare professionals with auditing… more
- Humana (Boston, MA)
- …you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider ... community and help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from...payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments.… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- … Auditor helps improve clinical outcomes and quality of care, to reduce medical expenses by conducting audits The Professional Auditor will be a subject ... transform healthcare? Bring your true colors to blue. About the Role: The Professional Auditor is responsible for post-pay review to verify the accuracy of claims… more
- Elevance Health (Woburn, MA)
- …spending. The **DRG CODING AUDITOR ** is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit ... **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ __ This...or quality assurance environment preferred. + Broad knowledge of medical claims billing/payment systems provider billing guidelines,… more
- Elevance Health (Woburn, MA)
- **Performance Quality Auditor I** **Location:** _Virtual:_ This role enables associate to work virtually full-time, with the exception of required in-person training ... is granted as required by law. The **Performance Quality Auditor I** is responsible for evaluating the quality of...Included are processes related to enrollment and billing and claims processing, as well as customer service written and… more
- Highmark Health (Boston, MA)
- …(Outpatient): Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA) + 5 years with hospital or ... related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding,… more
- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will ... (CPC) + Certified Inpatient Coder (CIC) + Certified Professional Medical Auditor (CPMA) **Desired Education (nice to...Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for… more