- UCLA Health (Los Angeles, CA)
- …career to the next level. You can do all this and more at UCLA Health. The Claims Quality Auditor will be responsible for the daily audit of all examiners ... assigned to the auditor . You will review claims (paid, pending,...maintain statistical data consistent + Maintain departmental production and quality standards Salary Range: $31.51 - $62.64 HourlyQualifications We're… more
- UCLA Health (Los Angeles, CA)
- …random and focus audits of all claim processing activities to identify inaccurate claims adjudication. This will involve reviewing UB04 and CMS 1500 healthcare ... claims and adjustments for accuracy, and appropriate application ...maintain statistical data and ensure compliance with production and quality standards in accordance with department policy. Salary Range:… more
- CHS (Clearwater, FL)
- **Overview** ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical ... equivalent is required + Experience in medical customer service, quality assurance, or insurance training is strongly preferred. **Certificates,...and lifting up to thirty (30) pounds. ** ** ** Claims and Call Auditor (Call Center QC)… more
- LA Care Health Plan (Los Angeles, CA)
- Specialty Health Plans Auditor III Claims Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...achieve that purpose. Job Summary The Specialty Health Plans Auditor III Claims is responsible for all… more
- 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 Hours: 40 ... 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
- WTW (Chicago, IL)
- **Description** As a Lead Auditor you will apply your audit, project management and client management skills to lead client audits. You will serve as the team leader ... will review discrepancy issues identified by field auditors, re-adjudicate claims , resolve open issues, and draft the final report....activities in an accurate and timely fashion + Write quality value-added draft report in a timely manner +… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure ... claims are processed in accordance with Federal, State and...keep up to date with departmental changes in conducting quality reviews. + Ensure the consistent use of current… more
- Boar's Head Brand/Frank Brunckhorst Co., LLC (Sarasota, FL)
- … Certification preferred (ie American Society for Quality - Certified HACCP Auditor , Certified Quality Auditor , Certified Supplier Quality ... BH Audit Team with performing Food Safety & Product Quality audits at different venues to include but not...COAs, Allergen forms, Weight & Tare, any other product claims , etc.), as applicable. + Perform Food Safety &… more
- Sedgwick (Des Moines, IA)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Independent Adjuster Auditor As an Independent Adjuster Auditor at Sedgwick, you'll have the ... professional needs. **PRIMARY PURPOSE** **OF THE ROLE** The Independent Adjuster Auditor reviews Independent Adjuster and other Non-Legal Vendor invoices on behalf… 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 ... accommodation is granted as required by law. The **Performance Quality Auditor I** is responsible for evaluating...Included are processes related to enrollment and billing and claims processing, as well as customer service written and… more
- Humana (Boise, ID)
- …Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider ... caring community and help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …with the Plans' provider agreements and the National Healthcare guidelines. The Professional Auditor helps improve clinical outcomes and quality of care, to ... 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
- Catholic Health Initiatives (Chattanooga, TN)
- **Job Summary and Responsibilities** **Job Summary / Purpose** The Sr Coding Compliance Auditor is responsible for reviewing chart notes for proper coding with an ... across the medical group. The Hierarchical Condition Category (HCC) Quality program was developed by CMS to promote ...met at the highest level. The Sr Coding Compliance Auditor 's primary focus will be to facilitate and ensure… more
- City of New York (New York, NY)
- Job Description Only permanent Administrative Management Auditor and Incumbent employees are eligible to apply. DCAS's mission is to make city government work for ... but in service of them all. It's an opportunity to provide impactful support, quality customer service, and help protect the future of New York City for generations… more
- Elevance Health (Chicago, IL)
- … AUDITOR ** is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines ... **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ __ This...AA/AS or minimum of 5 years of experience in claims auditing, quality assurance, or recovery auditing.… 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 ... and is responsible for the selection and auditing of claims , educating Prime's network pharmacies and driving contract compliance,...+ 2 years of work experience in audit or quality assurance + 1 year of work experience in… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- **42425BR** **Extended Job Title:** Medical Coding Auditor **Org Level 1:** Texas Tech Unv Hlth Sci Ctr El Paso **Position Description:** Responsible for auditing ... coding and compliance with regulatory requirements. This role ensures continuous quality improvement in coding practices while maintaining compliance with healthcare… more
- LA Care Health Plan (Los Angeles, CA)
- Specialty Health Plans Auditor III Finance **$5,000 Sign On Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...achieve that purpose. Job Summary The Specialty Health Plans Auditor III, Finance, is offering a $5,000 Sign-On. This… more
- UPMC (Pittsburgh, PA)
- …ICD-10-CM, CPT, and HCPCS codes to ensure consistency and efficiency in claims processing, data collection, and quality reporting. . **Regulatory Compliance:** ... **Join UPMC Corporate Compliance as an Intermediate Compliance Auditor !** Are you passionate about ensuring accuracy and compliance in healthcare documentation and… more
- Elevance Health (Los Angeles, CA)
- …applicable state(s). + Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum ... **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This...Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes… more