- Conduent (Los Angeles, CA)
- …pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety of pharmacy records against ... of a culture where individuality is noticed and valued every day. **Pharmacy Claims Auditor CPhT** **Do you have a CPhT certification?** **Would you like to… more
- Centene Corporation (Sacramento, CA)
- …Finance, Healthcare or equivalent experience preferred. + 2+ years claims compliance experience, preferably with State or Federal managed care programs required. ... PT to as late as 8:30am PT. **Position Purpose:** Perform regulatory claims compliance audits to support health plan operations. Completes retrospective claims… more
- Elevance Health (Walnut Creek, CA)
- **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This role enables associates to work virtually full-time, ... required by law. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to...Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes… more
- Sharp HealthCare (San Diego, CA)
- …calls in conjunction with management and Contract Reimbursement Specialist in reviewing claims processing and rejection issues that delay money collected and AR ... and resolve denied/underpaid accounts, and escalated payer trends/issues to ensure claims are processed and paid per the insurance contract.Other duties as… more
- Highmark Health (Sacramento, CA)
- …Depending on location provides or arranges for education/training of facility healthcare professionals in use of coding guidelines and practices, proper ... Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA) + 5 years with hospital or physician...skills Preferred + Associate's Degree + 3 years with claims processing and data management + Past auditing and… more
- Humana (Sacramento, CA)
- …for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare records + Must be able to work core business hours on EST time between ... of compliance risk across the organization. This team ensures that healthcare providers align their operational practices with legal requirements while fostering… more
- Insight Global (Irvine, CA)
- …with strong understanding of medical terminology. Previous experience as a medical claims examiner or auditor preferred. Experience with claim investigation, ... Job Description An employer in the Irvine area is seeking a Claims Examiner II. This is a hybrid position, working 1-2 days on site. The training for this role will… more
- DoorDash (San Francisco, CA)
- …business by managing corporate insurance programs and mitigating risk across Actuarial, Claims Operations, and Risk Management & Mitigation. We operate at the ... 29, 2024. The Covey tool has been reviewed by an independent auditor . Results of the audit may be viewed here: Covey (https://getcovey.com/nyc-local-law-144)… more
- DoorDash (San Francisco, CA)
- …automation of recurring workflows + Collaborate with cross-functional teams-including Claims , Finance, and Legal-to incorporate operational insights into actuarial ... 29, 2024. The Covey tool has been reviewed by an independent auditor . Results of the audit may be viewed here: Covey (https://getcovey.com/nyc-local-law-144)… more
- DoorDash (Sunnyvale, CA)
- …and safety alerts, provide instant support when incidents occur, and streamline claims through automated processes-all while gathering invaluable data that makes our ... 29, 2024. The Covey tool has been reviewed by an independent auditor . Results of the audit may be viewed here: Covey (https://getcovey.com/nyc-local-law-144)… more