- Elevance Health (St. Louis, MO)
- ** Claims Auditor I, II and Senior**...is designed to advance our strategy but will also lead to personal and professional growth for our associates. ... for employment, unless an accommodation is granted as required by law._ The ** Claims Auditor I** is responsible for pre and post payment and adjudication audits… more
- The County of Los Angeles (Los Angeles, CA)
- SENIOR CONTRACT PROGRAM AUDITOR Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/5040931) Apply SENIOR CONTRACT PROGRAM AUDITOR Salary ... individuals to fill the position of Senior Contract Program Auditor . To view classification standards for the position,Click here...so may result in an incomplete application and may lead to disqualification. We will send notifications to the… more
- Elevance Health (Hanover, MD)
- **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ __ This role enables associates to work virtually full-time, with the exception of required in-person training ... recover, eliminate and prevent unnecessary medical-expense spending. The **DRG CODING AUDITOR ** is responsible for auditing inpatient medical records and generating… more
- Elevance Health (Las Vegas, NV)
- **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This role enables associates to work virtually full-time, ... granted as required by law. The **Diagnosis Related Group Clinical Validation Auditor -RN** is responsible for auditing inpatient medical records to ensure clinical… 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
- Elevance Health (Tampa, FL)
- **Clinical Provider Auditor II (CPC)** **Hybrid 1:** This role requires associates to be in-office **1 - 2** days per week, fostering collaboration and connectivity, ... recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Provider Auditor II** is responsible for identifying issues and/or entities that… more
- Independent Health (Buffalo, NY)
- …fosters growth, innovation and collaboration. **Overview** The Quality Assurance Auditor will perform monitoring, oversight, and quality assurance reviews/audits of ... during the quality assurance process to ensure resolution. The Quality Assurance Auditor will analyze, document, and report on results to business stakeholders and… more
- CareFirst (Baltimore, MD)
- …for systematic investigations of a specific area of operations (ie, claims , customer service, enrollment) within the organization. Incumbent conducts a variety ... of systems and/or procedures used to review the effectiveness of Q/A efforts. Lead and participate in the completion of validating the accuracy of audits accordance… more
- Humana (Columbia, SC)
- …part of our caring community and help us put health first** The Risk Management Lead acts as a consultant to the Risk Adjustment team leaders, as programs and ... to evaluate business processes and drive improvements aimed at minimizing risk. The Lead will focus on Project Management and is responsible for oversight of the… more
- Sedgwick (Nashville, TN)
- …Defines, prepares, reviews and analyzes monthly reports. + Prepares audit lead schedules for outside audit firms. **QUALIFICATIONS** Bachelor's degree or equivalent ... in accounting field preferred. Certified Public Accountant (CPA), Certified Internal Auditor (CIA) or Certified Information Systems Auditor (CISA) certification… more
- Johns Hopkins University (Baltimore, MD)
- …+ Represent department on assigned Institutional committees + Mentor and guide internal auditor staff in the execution of their assigned projects. + Demonstrate a ... Associate Directors, Executive Director Operational Audits, and Chief Audit Officer. + Lead and/or direct work of audit staff regarding review of scope statements,… 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, ... discussions with Medical Directors and/or clinical consultants. + Serves as an internal auditor /peer reviewer for new clinical staff, as needed. + Mentors (to others… more
- The County of Los Angeles (Los Angeles, CA)
- …and our communities by providing extraordinary care. 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
- Amazon (San Francisco, CA)
- …sound monthly reserving process for Total Medical Expense (TME) estimation, and lead continuous evaluation of TME performance compared to plan expectations. Key job ... sound monthly reserving process for Total Medical Expense (TME) estimation - Lead continuous evaluation of TME performance compared to plan expectations -Coordinate… more
- System One (Lakewood, NJ)
- …a manufacturing environment, ideally with polymers. + ISO 9001:2015 experience required; ISO Lead Auditor certification a plus. + Knowledge of quality tools (eg, ... 4:30 pm We are seeking a proactive and experienced Quality Assurance Supervisor to lead our QA program and ensure that all products, materials, and processes meet… more
- McKinstry (Seattle, WA)
- …in LEAN Manufacturing preferred. + Lean Belt Certification preferred. + SO 9001:2015 Lead Auditor certification. + Working knowledge and understanding of the ISO ... + Oversee containment and countermeasure activities when production defects are discovered. Lead and document root cause analysis (RCA) for nonconforming product and… more
- CareFirst (Reston, VA)
- …Qualifications** **PURPOSE:** The Quality Assurance Specialist III is an advanced-level auditor position performing in-depth system and procedural audits. This role ... and procedures. **ESSENTIAL FUNCTIONS:** + Audits assigned function (service, claims , enrollment) for accuracy, benefit payment, contract interpretation, and… more
- The Diez Group (Dearborn, MI)
- …Enter feed forward information from the steel mills . Process monthly R1 Mill Claims . Monitors status of rejected/hold material in Hold Area and tracks disposition: ... professional in an industrial environment . Demonstrated ability to lead and develop staff members . Solid problem solving...to effectively handle multiple tasks at one time . Auditor Training a plus . Use of measuring equipment… more
- Trinity Health (Fresno, CA)
- …services into EMR system. Sorts and files paperwork and handles insurance claims . Responsibilities include primary diagnosis and procedural coding for the designated ... non-certified coding experience may substitute. 4. Certified Professional Medical Auditor (CPMA), Certified Coding Specialist (CCS)or Certified Coding Specialist… more
- Vibrant Emotional Health (New York, NY)
- …banking institution for all accounts payable disbursements and payroll checks issued. + Lead monthly close process and ensures that the monthly close calendar is ... annual audits - Manage/supervise the general accounting staff in providing external auditor request. + Provide assistance to the Controller with various finance… more