- Molina Healthcare (Syracuse, NY)
- JOB DESCRIPTION Job Summary Provides support for claims audit activities including identification of incorrect coding, abuse and fraudulent billing practices, ... claims errors. + Prepares, tracks and provides claims audit findings reports according to established...position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina… 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
- HCA Healthcare (Nashville, TN)
- …updating policies and procedures which support application system setup functions and work/ audit processes within claims processing platform. + Provider data ... Are you passionate about the patient experience? At HCA Healthcare , we are committed to caring for patients with...The Data Management team is responsible for ensuring that claims processing platform is optimally and accurately configured to… 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 (Cedar Rapids, IA)
- 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
- TEKsystems (Martinez, CA)
- …a large public health plan, has a need for a contract to hire Director of Claims . The group includes 20 direct reports including 2 managers, Claims supervisor, ... you start the job: a large backlog of pending claims which are in jeopardy of pending interest, performance...function to ensure accurate, timely, and compliant payment of healthcare services. This position is responsible for setting direction,… more
- Henry Ford Health System (Detroit, MI)
- …and general liability, workers compensation and employers liability claims review, investigation, management and disposition, including financial mitigation ... and management of System reputation Will work under the guidance of Senior Claims Managers, Senior Claims Consultant, Director of Insurance, and Vice President,… more
- TEKsystems (Santa Barbara, CA)
- …communication skills. Core Responsibilities + Research, correct, and respond to all D-SNP pended claims in a timely manner. + Review audit reports and determine ... additional duties and special projects as assigned. Skills + Claims Processing + Project Management + Healthcare ...+ Claims Processing + Project Management + Healthcare Operations + Workflow Optimization + Medical Terminology &… 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
- Humana (Madison, WI)
- …3 works with insurance companies, providers and internal resources to validate and audit claims payments, request refunds for overpayments and work with ... caring community and help us put health first** The Claims Research & Resolution Representative 3 manages claims...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also… more
- Elevance Health (Atlanta, GA)
- …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
- Marshfield Clinic (Marshfield, WI)
- …come together to support the most exciting missions in the world!** **Job Title:** Claims Auditor (Remote - WI or MN) **Cost Center:** 682891379 SHP- Claims ... shifts (United States of America) **Job Description:** **JOB SUMMARY** The Claims Auditor is responsible for performing payment, procedural accuracy, turnaround… more
- TEKsystems (Santa Barbara, CA)
- …This role involves: + Researching, correcting, and responding to all D-SNP pended claims in a timely manner. + Reviewing audit reports and determining ... other duties and projects as assigned. Required Skills + Claims processing + Healthcare knowledge Additional Skills & Qualifications + Experience with QNXT… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … more
- Elevance Health (Atlanta, GA)
- …and medical policy guidelines strongly preferred + BA/BS preferred + Medical claims review with prior health care fraud audit /investigation experience preferred ... **Nurse Auditor Senior - Payment Integrity Complex and Clinical Audit ** **Location:** This role enables associates to work virtually full-time, with the exception of… more
- AbbVie (North Chicago, IL)
- …of the different industries and associated business models. The Global Compliance Audit Associate Director has the primary function to lead/manage global sales and ... marketing, corporate functions, and other healthcare compliance audits. The role will assist the Director...business risks for US/International locations and recommend a thoughtful audit approach. The role will also manage the … more
- Elevance Health (Richmond, VA)
- Manager of DRG Coding Audit -Program/Project Locations: _The selected candidate must reside within a reasonable commuting distance of the designated posting ... **How you will make an impact:** .Sets the strategic direction for audit methodologies, oversees team development, and ensures that audits meet the industry's… more
- Molina Healthcare (Hartford, CT)
- …but reside in Connecticut** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network ... utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on… more