- WTW (Houston, TX)
- **Description** As a Medical Claim Lead Auditor , you will apply your audit, project management and client management skills to lead client audits. ... Develop working relationship with vendor counterparts + Distribute individual claim /work queues to team in a timely manner +...Managed Care + Must demonstrate a high level of claims administration knowledge, including experience with medical ,… more
- Elevance Health (Boston, MA)
- …all the above, plus: Independently interprets Medical Policy and Clinical Guidelines. + ** Claims Auditor Senior** - all the above, plus : Service as a ... ** Claims Auditor I, II and Senior**... payment accuracy by verifying various aspects of the claim including eligibility, pre-authorization, and medical necessity.… more
- Elevance Health (Chicago, IL)
- …spending. The **DRG Coding Auditor Principal** is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) ... letter writing) on lower level auditors. + Identifies new claim types by identifying potential claims outside...environment preferred. + Broad, deep and niche knowledge of medical claims billing/payment systems provider billing guidelines,… more
- Elevance Health (Chicago, IL)
- …spending. The **DRG CODING AUDITOR ** is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit ... coding or quality assurance environment preferred. + Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- **42910BR** **Extended Job Title:** Medical Coding Auditor **Org Level 1:** Texas Tech Unv Hlth Sci Ctr El Paso **Position Description:** Responsible for ... while maintaining compliance with healthcare laws and organizational policies. The Medical Coding Auditor collaborates with practice, providers, and other… more
- Elevance Health (Chicago, IL)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... required by law. The **Diagnosis Related Group Clinical Validation Auditor -RN** is responsible for auditing inpatient medical ...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… more
- Northwell Health (Lake Success, NY)
- **Req Number** 172252 Surgical Anesthesia Compliance AuditorCompliance Auditor MUST HAVE CPC CERTIFICATON This is a HYBRID position- MUST be in the office located in ... Chappaqua, NY 3 days a week. Surgical Anesthesia Compliance Auditor - Hybrid position- Chappaqua, NY- $100K-$115K Are you passionate about healthcare compliance and… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Revenue Integrity Auditor Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the region's top-performing healthcare ... , outpatient and specialty services (http://www.covenanthealth.com/services/) , and Covenant Medical Group (http://www.covenantmedicalgroup.org/) , our area's fastest-growing physician practice… 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 ... **Nurse Auditor Senior - Payment Integrity Complex and Clinical...impact:** + Investigates potential fraud and over-utilization by performing medical reviews via prepayment claims review and… more
- Mendocino County Sheriff's Office (Ukiah, CA)
- Accountant Auditor II - Confidential Print (https://www.governmentjobs.com/careers/mendocinoca/jobs/newprint/5179108) Apply Accountant Auditor II - ... office cash to internal and bank records. + Prepares claims for reimbursement of mandated costs. + Assists departments...functions. + May train other staff. + Serves as lead professional on special projects. + Perform other related… more
- Robert Half Finance & Accounting (Kansas City, MO)
- Description We are seeking a skilled Revenue Systems Auditor to lead compliance assurance and auditing functions across Skilled Nursing and Senior Living ... trust account activities. + Diagnose and resolve system issues that affect claim processing and payments, introducing improvements to support workflow efficiency. +… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …valued member of the Audit and Risk Management (ARM) team, the Senior Internal Auditor will lead and execute a variety of financial, operational, and risk-based ... reporting and risk-based audits of these areas (eg Enrollment, Premiums, Claims Operations, Provider Enrollment and Pricing, Accounting, and Information Technology… more
- Amazon (San Francisco, CA)
- …of actuarial reserving, forecasting and medical economics -Expertise in working with medical claims data and using programming languages such as SQL, R, SAS, ... data, design and implement an actuarially sound monthly reserving process for Total Medical Expense (TME) estimation, and lead continuous evaluation of TME… more
- Quality Technology Services, LLC (Overland Park, KS)
- …them on-the-job coaching. + Monitor the status of new data center builds, lead compliance readiness sessions for new sites, and collaborate with external audit ... or more professional certifications such as Certified Information Systems Auditor (CISA), Certified Information Security Manager (CISM), Certified Information… more
- Wabtec Corporation (Duncan, SC)
- …offer fantastic benefits and a stable work environment. Benefits include medical /dental/vision as well as many supplemental options at low rates. Company-provided ... **KPIs** with all Project Core Team members and PL Quality Management (PPR) Lead and Manage the **Customer issues** in the project, according to Wabtec rules… more
- RKON (Chicago, IL)
- …and policy modernization. + Industry-related certifications: CISSP, CISM, CISA, CRISC, ISO 27001 Lead Auditor or Lead Implementor Compensation: The base ... programs, including risk registers, treatment decisions, and maturity tracking. + Lead audit and compliance readiness across common security and compliance… more
- McKinstry (Spokane, 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
- State of Montana (Helena, MT)
- …* Conduct investigations, write reports, and make recommendations based on conclusions. * Lead responses to grievances, formal complaints, or claims . * Provide ... *Why Work with Us?* The Montana State Auditor , Commissioner of Securities and Insurance (CSI), has...competitive compensation and generous benefits. * Work/life balance * Medical , dental, and vision coverage * Retirement plans *… more
- ProAmpac Holdings, Inc. (Cincinnati, OH)
- …improvement and sustainment translating strategy into actionable project plans. + Serves as lead auditor for audits of facilities, tracks audit completion, and ... for Worker's Compensation and Property Insurance policies and monitors high risk claims . + Support employee engagement and EHS communications through media sources… more
- Howmet Aerospace (City Of Industry, CA)
- …issues to identify root causes and drive resolutions * Handle customer claims and rejections through quality portals * Accurately log non-conformances and inspection ... results in SAP and Excel * Take the lead or support during internal and external audits, including...Holder), Political Asylee, or Refugee Preferred Qualifications * Internal auditor certifications (AS9100 or ASQ CQA/CQI) a plus *… more