- Premera Blue Cross (Mountlake Terrace, WA)
- … processing, provider relations, special investigations unit). + Utilize auditing software and systems to document, track, and analyze claims data. + Stay ... serve through our Healthsource blog: https://healthsource.premera.com/ . As a **Payment Integrity Auditor I** , you will support the overall objectives of the… more
- County of Santa Barbara (Santa Barbara, CA)
- …and maintenance of budgets and budgetary controls; confers and cooperates with Auditor -Controller staff and systems analysts to implement and improve automated ... fiscal systems . Prepares, reviews, and monitors grants, contracts, claims and other fiscal agreements and proposals. Prepares financial statements, balance… more
- County of Santa Barbara (Santa Barbara, CA)
- …with County Administrator staff regarding budgets for major programs and the Auditor -Controller staff to assure full cost recovery and proper reporting; participates ... in the development of specialized cost accounting systems ; and performs related duties as required. DISTINGUISHING CHARACTERISTICS: Cost Analyst I/II is a flexibly… more
- Elevance Health (St. Louis, MO)
- ** Claims Auditor I, II and Senior**...and post payment and adjudication audits of high dollar claims for limited lines of business, claim ... an accommodation is granted as required by law._ The ** Claims Auditor I** is responsible for pre...an impact :** + Performs audits of high dollar claims . + Ensures claim payment accuracy by… more
- UCLA Health (Los Angeles, CA)
- …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,...+ Computer proficiency with Microsoft Office + Knowledge of claims adjudication systems + Flexibility and adaptability… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …including basic analysis of identified trends. + Analyzes audit results to recommend system or procedural changes to increase claim accuracy and/or identify ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … more
- Commonwealth of Pennsylvania (PA)
- …Manager (CGFM) + Certified Internal Auditor (CIA) + Certified Information Systems Auditor (CISA) Legal Requirements: + A conditional offer of employment ... to audit every municipality which received general municipal pension system state aid. Work duties include, but are not...Certified Internal Auditor (CIA) + Certified Information Systems Auditor (CISA) + None 05 I… more
- New York State Civil Service (Syracuse, NY)
- NY HELP Yes Agency Taxation & Finance, State Title Auditor 1 (Tax)/ Auditor Trainee 1 (Tax)/ Auditor Trainee 2 (Tax) (NY HELPS) Occupational Category ... City Syracuse State NY Zip Code 13202 Duties Description Auditor 1 (Tax) performs on-site field audits and examinations...and advocate disputed cases at BCMS conferences and Small Claims Hearings. May participate at hearings as a witness… more
- BayCare Health System (Tampa, FL)
- …AM to 3:30 PM + **Days:** Monday - Friday The **Inpatient** **Coding Auditor ** is a full-time remote position. _Sign on bonuses available!_ **Responsibilities** + ... The Inpatient Coding Auditor performs inpatient encounter audits and evaluates compliance related...related activities and services provided by the BayCare Health System HIM Coding Department. + Interacts directly with coders,… more
- Elevance Health (Hanover, MD)
- …claim identification, and documentation purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside of the concept ... **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ __ This...quality assurance environment preferred. + Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer… more
- MAPFRE Insurance (Webster, MA)
- …designation, Certified Internal Auditor (CIA) designation or Certified Information Systems Auditor (CISA) designation preferred + 1-2 years of insurance ... Internal Auditor (Webster or Boston, MA) Date: Oct 21,...industry knowledge ( Claims , Underwriting, Insurance Operations, etc.)An understanding of internal audit… more
- UPMC (Pittsburgh, PA)
- …coding/classification systems appropriate for inpatient /outpatient, DRG prospective payment system or office setting E/M codes. + Experience in an academic ... **Join UPMC Corporate Compliance as an Intermediate Compliance Auditor !** Are you passionate about ensuring accuracy and compliance in healthcare documentation and… more
- Insight Global (South Jordan, UT)
- …valid claim identification and documentation (letter writing). Identifies potential claims outside of the concept where additional recoveries may be available. ... Job Description Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100%...AP-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer… more
- Independent Health (Buffalo, NY)
- …or another government program strongly preferred. + Experience with pharmacy on-line claims processing systems preferred. + Strong analytical, problem solving, ... process. + Conduct internal audits to measure and ensure adherence to claims processing standards, technical requirements, supporting processes, systems , and… more
- Elevance Health (Las Vegas, NV)
- …preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems , provider billing guidelines, payer ... **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
- Sharp HealthCare (San Diego, CA)
- **Facility:** System Services **City** San Diego **Department** **Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Certified ... remote position* **What You Will Do** The Compliance Coding Auditor is responsible for the administration of the Sharp...coding or professional E/M coding in the following coding systems : ICD-10-CM/PCS, DRG, CPT& HCPCs, and/or E/M CPT. **Preferred… more
- Highmark Health (Harrisburg, PA)
- …to resolve issues and provide advice on new programs. Provides guidance to system entities in response to external coding audits conducted by the Medicare ... the ICD-CM, ICD-PCS, CPT and HCPCS Level II code and modifier systems , missed secondary diagnoses and procedures and ensures compliance with DRG/APC structure… more
- Sedgwick (Indianapolis, IN)
- …Accountant (CPA), Certified Internal Auditor (CIA) or certified Information Systems Auditor (CISA) designation preferred. Experience: Four (4) years of ... to Work(R) Fortune Best Workplaces in Financial Services & Insurance Internal auditor **PRIMARY PURPOSE OF THE ROLE:** To perform internal audit procedures under… more
- UPMC (Pittsburgh, PA)
- …coding/classification systems appropriate for inpatient /outpatient, DRG prospective payment system or office setting E/M codes. + Experience in an academic ... **Join UPMC Corporate Finance as a Compliance Auditor , Associate!** Are you detail-oriented and passionate about ensuring compliance in healthcare? **UPMC Corporate… more
- Elevance Health (Hanover, MD)
- **Clinical Provider Auditor II** **Supports the Payment Integrity line of business** **Hybrid 1** : This role requires associates to be in-office **1-2** days per ... recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Provider Auditor II** is responsible for identifying issues and/or entities that… more
