- Molina Healthcare (Mesa, AZ)
- …and the Affordable Care Act (ACA). + Medical Coding certification. + Strong Medical Claims Audit knowledge To all current Molina employees: If you are interested ... to support systems solutions development and maintenance for Medical Claim Audit . This role includes coordination with stakeholders and subject matter experts… more
- Molina Healthcare (AZ)
- …hypothesis, and measurable success criteria (eg, first-pass resolution, auto-adjudication rate, claims cycle time, audit findings, cost-to-serve). + Process ... PMO standards, stage gates, and financial controls. + **Operational & Regulatory Acumen ( Healthcare / Claims )** + Deep understanding of claims lifecycle, EDI… 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
- Grant Thornton (Los Angeles, 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
- MyFlorida (Tallahassee, FL)
- …until deficiencies are cured and issues are resolved. + Manages the post payment claims audit contract, serves as the Division's liaison with the contracted ... claims audits and the Pharmacy Benefits Manager compliance audit . This position is essential to managing all ...years of experience in a related field such as: healthcare , finance, accounting, business or risk management, or a… 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
- 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
- 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
- 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
- Elevance Health (Indianapolis, IN)
- …to worksite and other locations as necessary + BA/BS preferred + Medical claims review with prior health care fraud audit /investigation experience preferred + ... **Nurse Audit Senior - Payment Integrity Complex and Clinical...and/or fraudulent activities by health care providers through prepayment claims review, post payment auditing, and provider record review.… 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
- Owens & Minor (Downers Grove, IL)
- At Owens & Minor, we are a critical part of the healthcare process. As a Fortune 500 company with 350+ facilities across the US and 22,000 teammates in over 90 ... Our mission is to empower our customers to advance healthcare , and our success starts with our teammates. Owens...and timely manner. + Log and report all received audit inquiries including: + Prepayment audits/development letters + Post… 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
- 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
- Elevance Health (Cincinnati, OH)
- **Business Architect Sr. - Government Claims ** **Location:** This role requires associates to be in-office 1 day per week, fostering collaboration and connectivity, ... is granted as required by law. The **Business Architect Sr. - Government Claims ** will be part of Elevance Health's National Operations Command Center (NOCC) which… more