- Healthfirst (NY)
- …+ **Conduct moderately complex to complex quality audits of provider claims , pre-payments and post-payments including high-dollar and specialized claims ... to ensure the quality of the network.** + **Review and investigate claims and encounters for medical, facility, pharmacy, dental and vision services including… more
- City of New York (New York, NY)
- Job Description APPLICANTS MUST BE PERMANENT IN THE MANAGEMENT AUDITOR CIVIL SERVICE TITLE OR BE PERMANENT IN A COMPARABLE TITLE ELIGIBLE FOR 6.1.9 TITLE CHANGE. IF ... YOU ARE HIRED PROVISIONALLY AS A MANAGEMENT AUDITOR , YOU MUST TAKE AND PASS THE MANAGEMENT ...standard audit procedures examine records and documents that support claims submitted to Medicaid for reimbursement for goods or… 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 - ... professional auditing standards in a law enforcement agency. OPTION II : Three years of professional auditing experience, with a...No 10 In the execution of the Law Enforcement Auditor duties, you will have to make site visits… more
- Highmark Health (Harrisburg, PA)
- …coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure ... + Validates the ICD-CM, ICD-PCS, CPT and HCPCS Level II code and modifier systems, missed secondary diagnoses and...Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA) + 5 years with hospital or physician… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in a clear and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. + Manages cases as assigned, ... + Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) + Performs...Directors and/or clinical consultants. + Serves as an internal auditor /peer reviewer for new clinical staff, as needed. +… more
- The County of Los Angeles (Los Angeles, CA)
- …permanent appointment to Health Care Financial Analyst. DEFINITION: Prepares reimbursement claims for health and/or mental health care provided under Federal, State ... requirements for Federal, State, and/or Special Programs to determine if claims for reimbursement conform to applicable rules and regulations and result… more
- The County of Los Angeles (Los Angeles, CA)
- …requirements for Federal, State, and/or Special Programs to determine if claims for reimbursement conform to applicable rules and regulations and result ... Health Services or Mental Health, departmental administration and by the Auditor -Controller when necessary. Writes policy and procedure manuals pertinent to… more
- RKON (Chicago, IL)
- About us: RKON is an ISO27001 and AICPA SOC 2 Type II certified company that specializes in providing IT migration and transformation services for the Mergers and ... access management and zero trust strategies. + Cyber insurance readiness and claims advisory. + M&A cyber due diligence and post-close security integration. +… more