• Payment Integrity Nurse

    LA Care Health Plan (Los Angeles, CA)
    Payment Integrity Nurse Coder RN III Job Category: Clinical Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position Type: Full ... to support the safety net required to achieve that purpose. Job Summary The Payment Integrity Nurse Coder RN III is responsible for investigating,… more
    LA Care Health Plan (06/24/25)
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  • Medical Claim Review Nurse (RN) Remote IL &

    Molina Healthcare (WI)
    …Level of Care, Inpatient Readmission, and any opportunity identified by the Payment Integrity analytical team; requires decision making pertinent to clinical ... be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous claims and appeals experience. The candidate must have strong… more
    Molina Healthcare (06/22/25)
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  • Compliance Auditor, Associate

    UPMC (Pittsburgh, PA)
    …Auditor, Associate** to join our team. This role is crucial in maintaining the integrity of our coding and billing processes, ensuring they meet state and federal ... to hear from you! Apply now and join a team that values precision, integrity , and strategic thinking. + High School Diploma or equivalent required. + Associate's… more
    UPMC (04/24/25)
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  • Compliance Auditor, Intermediate (Cemc, CPC,…

    UPMC (Pittsburgh, PA)
    …will play a crucial role in upholding our standards and ensuring the highest level of integrity in our operations. Join us and be part of a team that values your ... + Knowledge of coding/classification systems appropriate for inpatient /outpatient, DRG prospective payment system or office setting E/M codes. + Experience in an… more
    UPMC (06/06/25)
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  • Manager, DRG Coding & Validation (RN) Remote

    Molina Healthcare (Columbus, OH)
    …Responsible for auditing inpatient medical records and generating high quality claims payment to ensure payment integrity . Responsible for performing ... in reimbursement guidelines specifically related to MS-DRG, AP-DRG and APR-DRG payment systems. Key participant in the development and implementation of the… more
    Molina Healthcare (06/14/25)
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