- Solugenix (Los Angeles, CA)
- Financial Compliance Auditor III, Claims Los Angeles, CA (Remote/Hybrid) 3-Month Contract (Possibility of conversion to a permanent position) Job ID 25-09703 ... health insurance company, in their search for a Financial Compliance Auditor III, Claims. This is a...for a variety of complex areas of the Medi-Cal, Medicare , Covered California, and PASC-SEIU benefits and processes. This… more
- Aquent (Los Angeles, CA)
- …Make a real impact on healthcare accessibility and affordability as a Financial Compliance Auditor with a mission-driven organization partnered with Aquent. You ... play a vital role in ensuring the financial integrity and regulatory compliance of healthcare claims, directly contributing to the organization's mission of… more
- Optum (San Juan, PR)
- …Investigate and pursue recoveries Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance Use pertinent ... - 10% Keep up required Coding Certificate and/or Nursing Licensure Complete compliance hours as required by the department ENGLISH PROFICIENCY ASSESSMENT WILL BE… more
- SCAN (Long Beach, CA)
- …possible updates due to audit results and/or change in regulations Work with the Medicare Compliance team when new regulations are released to ensure appropriate ... training. 5+ years' experience in managed health care required. 3+ years compliance experience Demonstrated knowledge of the Medicare Advantage Program and… more
- Elara Caring (Fort Worth, TX)
- …Time, in the Right Place. **Job Description:** **REMOTE POSITION** The Billing Compliance Auditor performs comprehensive audits within the Skilled Home Health, ... Care Services (PCS) agencies at Elara Caring to ensure compliance with Medicare and Medicaid regulations and...billing, coding, and clinical documentation. Duties of the Billing Compliance Auditor include but are not limited… more
- Trinity Health (Syracuse, NY)
- …if needed. Auditing Experience Posting **POSITION PURPOSE:** A Risk Adjustment Auditor Educator is responsible for ensuring accurate coding and documentation in ... They work to improve documentation quality, identify coding discrepancies, and ensure compliance with regulations as well as supporting SJH, CNY AIM and Trinity… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Quality Auditor II Job Category: Customer Service Department: Even MORE Quality Location: Los Angeles, CA, US, 90017 Position Type: Full ... that purpose. Job Summary The Customer Solution Center Quality Auditor (QA) II is responsible for monitoring and actively...daily error reports, analyze results from Call Center, MRP, Medicare , MRU, Outbound and Outreach, and LA Care Covered… more
- MedKoder (Mandeville, LA)
- …services including evaluation and management, diagnostics, surgeries, and procedures in compliance with applicable Medicare , Medicaid, and third-party payer ... work week that offers a flexible schedule Description: Physician Coding Auditor is responsible for reviewing and accurately coding all professional multi-specialty… more
- LA Care Health Plan (Los Angeles, CA)
- …Health Plans Auditor III Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... net required to achieve that purpose. Job Summary The Specialty Health Plans Auditor III is responsible all aspects of planning, execution, reporting and corrective… more
- CHS (Clearwater, FL)
- **Overview** ** ** **Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical insurance ... claims and customer service calls to ensure validity, accuracy, and compliance with appropriate policies, procedures, and regulations + **Health, Dental, Vision, and… more
- AdventHealth (Altamonte Springs, FL)
- …to achieve industry best practice levels of performance. The Corporate Quality Auditor will adhere to AdventHealth Corporate Compliance standards, as well ... you will contribute:** The inpatient or outpatient coding team Corporate Quality Auditor (QA)/Educator supports the operations of the inpatient or outpatient coding… more
- Nuvance Health (Pembroke Pines, FL)
- …* Lead educational sessions for coders based on audit findings to reinforce compliance with CMS, Medicare , state/federal regulations, and internal policies. * ... TN, TX, and VA. *Job Title: Senior Professional Facility Auditor * *Company: Nuvance Health* *Department: Facility Charging and Coding*...Stay current with CMS, NGS Medicare , AAPC, and OIG updates, bulletins, and … more
- State of Maine, Bureau of Human Resources (Augusta, ME)
- Staff Auditor I Augusta , Maine , United States | Auditor | Full-time | Partially remote Apply by: July 31, 2025 Apply with Linkedin Apply Department of Health ... to its staff. ABOUT THE POSITION: As a Staff Auditor I you will: + Perform professional audit work...funds through contracts with DHHS. + Complete financial and/or compliance audits for conformance to established laws, rules, regulations… more
- Point32Health (MA)
- …Summary** Under the direction of the A&G Manager, the Appeals & Grievances QA Auditor audits the quality of letters and keyed entries from the Grievance and Appeals ... for the A&G department to reduce the risk of non- compliance with appeals and grievance requirements. These can include,...leads to discuss issues and trends identified. The A&G auditor will lead these meetings to discuss trends identified… more
- Nuvance Health (Danbury, CT)
- *Description* *Summary:* The Charge Integrity Auditor performs detailed chart to bill audits of inpatient or outpatient medical accounts, comparing the medical ... documented charging practices across the Nuvance Health System. The Charge Integrity Auditor coordinates and reports audits savings or losses for the facilities and… more
- Baystate Health (Springfield, MA)
- …documentation for professional billing to ensure it meets the AMA and CMS ( Medicare ) guidelines for the services billed, reviewing and validating billed charges and ... interacts with employees at all levels. The incumbent has an understanding of compliance audit concepts. This includes but is not limited to relaying confidential… more
- Trinity Health (Boise, ID)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The Coding Auditor & Educator performs medical record audits including analysis of medical ... and procedure codes using coding guidelines established by the Centers for Medicare and Medicaid Services (CMS). Monitor's accuracy of centralized coder's charge… more
- Humana (Indianapolis, IN)
- …our caring community and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct ... established guidelines/procedures. **Where you come in** The Medical Coding Auditor confirms correct CPT coding assignments. Analyzes, enters, and manipulates… more
- UCLA Health (Los Angeles, CA)
- …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, and denied)...services, contract interpretation, Division of Financial Responsibility (DOFR), and application/ compliance with policies and procedures. You will: + Research… more
- Atlantic Health System (Morristown, NJ)
- …assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines and provide ongoing feedback and analysis of ... + Audit charts for accurate and correct coding and compliance within documentation guidelines and AHS policies + Prepares...and billing department + Provides clarification on coding and compliance policies Required: * CPC Certification * Minimum 6… more
