- Elevance Health (Boston, MA)
- ** Claims Auditor I, II and Senior** **Location...interprets Medical Policy and Clinical Guidelines. + ** Claims Auditor Senior** - all the above, plus ... an accommodation is granted as required by law._ The ** Claims Auditor I** is responsible for pre...various aspects of the claim including eligibility, pre-authorization, and medical necessity. + Contacts others to obtain any necessary… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, ... direction and receives guidance where needed. Follows established guidelines/procedures. The Medical Coding Auditor confirms correct CPT coding assignments.… more
- Sedgwick (Providence, RI)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Attorney Auditor ** **This is a fully remote position, and candidates residing in any ... United States are encouraged to apply. As an Attorney Auditor at Sedgwick, you'll have the opportunity to take...opportunities. + A diverse and comprehensive benefits offering including medical , dental vision, 401K and PTO. + Wellness benefits… more
- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will ... (CPC) + Certified Inpatient Coder (CIC) + Certified Professional Medical Auditor (CPMA) **Desired Education (nice to...Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for… more
- Sedgwick (Providence, RI)
- …Major in accounting or technology field strongly preferred. Certified Internal Auditor (CIA), Certified Public Accountant (CPA), Certified Information Systems ... Auditor (CISA), or other professional certification designation is required....benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- Humana (Boston, MA)
- …Bachelor's degree - Accounting, Finance, Business, Auditing, Actuarial + Certified Internal Auditor , CPA or CPC strongly preferred + Risk Adjustment knowledge + ... + Auditing experience + Familiarity with CMS Reimbursement models and claims /encounter submission processes + Data analysis and dashboarding experience + People… more