- Stanford Health Care (Palo Alto, CA)
- …assignments, while identifying instances of overpayments and underpayments. Proficiency in healthcare claims analysis, including the ability to review, ... Stanford Health Care job.** **A Brief Overview** Clinical Government Audit Analyst and Appeal Specialist II plays a critical...interpret, and evaluate claims data to identify trends, discrepancies, and opportunities for… more
- Stanford Health Care (Palo Alto, CA)
- …identifying areas for improvement. This role ensures consistency in charge capture, claims submission, and reimbursement to safeguard revenue and minimize risk. The ... for both commercial and public payers. Additional duties include developing audit templates, performing routine compliance monitoring, analyzing data to identify… more
- Lundbeck (Deerfield, IL)
- …recommend and provide follow-up and appropriate corrective action. Support investigation audit reporting by extracting and consolidating data from multiple sources, ... Accredited bachelor'sdegree. + 3+ years of Compliance-related experience in the healthcare industry (ie. pharmaceutical, medical device, biologics, healthcare or… more
- Stanford Health Care (Palo Alto, CA)
- …including the Corporate Compliance Committee, the Executive Compliance Committee, the Audit , Compliance, and Enterprise Risk (ACER) Committees of the Boards of ... from an accredited college or university Required + Advanced degree in healthcare , healthcare administration, or law Preferred **Experience Qualifications** +… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …Revenue Cycle Center to address coding issues related to professional billing claims . The incumbent is responsible for reviewing provider charges to ensure accuracy, ... to Revenue Cycle Leadership. The incumbent will recommend coding changes based on audit & research. The incumbent will assist departments with resolution of claim… 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
- Molina Healthcare (OH)
- …Responsible for accurate and timely auditing of critical information on claims databases. Maintains critical auditing and outcome information. Synchronizes data ... among operational and claims systems and application of business rules as they...and in accordance with unit standards. **Knowledge/Skills/Abilities** * Trains audit staff on configuration functionality, enhancements and updates. *… 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 ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/227013/vice-president-of-health-plan-operations-and- claims /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime … more
- Molina Healthcare (Kearney, NE)
- JOB DESCRIPTION Job Summary Provides support for claims recovery activities including researching claim payment and billing guidelines, audit results, and ... to facilitate recovery of outstanding overpayments. Monitors and controls backlog and workflow of claims and ensures that claims are settled in a timely fashion… more
- Grant Thornton (Newport Beach, CA)
- As a Healthcare Process Risk Senior Associate, you will get the opportunity to grow and contribute to our clients' business needs by helping them understand their ... The ideal candidate will have exceptional expertise and experience in healthcare providers, specifically hospitals, academic medical centers, and healthcare … more
- The Cigna Group (Bloomfield, CT)
- The Quality Review & Audit Senior Analyst exhibits expertise in evaluating complex medical documentation for diagnosis code accuracy and compliance in support of the ... (HCC) expertise, evaluating data accuracy and record compliance, executing on audit requirements, and identifying and recommending process improvements within the RA… more
- LA Care Health Plan (Los Angeles, CA)
- Financial Compliance Auditor III Claims Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: Full ... that purpose. Job Summary The Financial Compliance Auditor III Claims is responsible for audits of claims ...responsible for all aspects of assigned claim audits, including audit testing and completion of the audit … more
- Dignity Health (Bakersfield, CA)
- …lead role, with strong project team management skills. - Advanced knowledge of healthcare claims processing, coding (ICD-10, CPT, HCPCS), and billing practices. ... for audit purposes. - Collaborate with internal departments, including claims processing, UM, compliance, and provider relations, to develop and implement… 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 **_This position is available to remote employees...claims systems (eg, Salesforce, Facets) in compliance with audit standards and MassHealth requirements. + Maintain awareness of… more
- Robert Half Accountemps (Boston, MA)
- …Requirements Required Qualifications + 3-5 years of experience in auditing, compliance, or claims analysis within a healthcare setting + Proficiency in Microsoft ... Description Job Title: Medical Claims Auditor - RN Auditor Location: Massachusetts -...Job Description We are seeking a qualified Auditor with healthcare experience to support Program Integrity activities for a… more
- Centene Corporation (Indianapolis, IN)
- …issues and inquiries. + Track claims quality trends and review Internal Audit claims quality results (with a focus centered on manual errors); coordinate ... or CPT.** **Position Purpose** Manage the prospective review of high risk claims to ensure payment integrity and provide immediate feedback on findings including… more
- Johns Hopkins University (Baltimore, MD)
- …within two years of hire.) + Eight years of accounting or audit experience in non-profit, healthcare or higher education setting. **Preferred ... **General Summary** We are seeking an **Internal Audit Manager,** who demonstrates subject matter expertise in operational internal auditing and the healthcare … more
- DoorDash (Tempe, AZ)
- …company's bottom line. The team is divided into three separate subgroups: Actuarial, Claims Operations, and Risk Management & Mitigation. We are looking for forward ... cross-functional partners at DoorDash. About the Role We are seeking an experienced claims specialist who will be a member of DoorDash's Corporate Risk & Insurance… more
- Elevance Health (Mendota Heights, MN)
- …leading Claims Operations teams and strategy within a large healthcare payor environment strongly preferred. + Proven track record leading Digital Transformation ... **Director II, Digital Claims Operations (Dir II Digital Ops)** Location: This...Benefits Administration, Provider Engagement and Contracting, Sales and Internal Audit . + Hires, trains coaches, counsels, and evaluates performance… more
- Dignity Health (Bakersfield, CA)
- …or GED + Minimum 5 years of progressive experience in healthcare claims recovery, payment integrity, or post-payment audit functions, preferably within a ... **Job Summary and Responsibilities** The Claims Recovery Manager is responsible for leading the...The Recovery Manager works in close coordination with internal audit , provider dispute resolution, and finance to maximize cost… more
