- Healthfirst (NY)
- …performance to ensure the quality of the network.** + **Review and investigate claims and encounters for medical, facility, pharmacy , dental and vision services ... + **Conduct moderately complex to complex quality audits of provider claims , pre-payments and post-payments including high-dollar and specialized claims … more
- MyFlorida (Tallahassee, FL)
- … and contract manager for the state group insurance program's post payment claims audits and the Pharmacy Benefits Manager compliance audit. This position ... be knowledgeable and experienced in auditing and monitoring, financial and claims data analysis, data collection methods, generally accepted accounting principles,… more
- Option Care Health (Bannockburn, IL)
- …to analyze large datasets, such as related to healthcare operations, billing, claims , and patient information to support Compliance activities and to identify ... methodologies. + Certified in Healthcare Compliance (CHC), Certified Internal Auditor (CIA), Certified Fraud Examiner (CFE), or similar certification preferred.… more
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