• Claims and Call Auditor (Call Center…

    CHS (Clearwater, FL)
    **Overview** ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical ... and procedures. + Reviews Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) to determine proper...and lifting up to thirty (30) pounds. ** ** ** Claims and Call Auditor (Call Center QC)… more
    CHS (06/14/25)
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  • Inpatient DRG Quality Auditor

    Humana (Tallahassee, FL)
    …Coding Quality Team is looking is an experienced and well-grounded medical coding auditor to quality review the inpatient hospital claims for proper ... this role, you will conduct quality reviews of coding processes within the Claims Cost Management organization, including offshore and vendor partners, with a focus… more
    Humana (07/25/25)
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  • DRG Coding Auditor

    Elevance Health (Tampa, FL)
    **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ _​_ _This role enables associates to work virtually full-time, with the exception of required in-person training ... recover, eliminate and prevent unnecessary medical-expense spending. The **DRG CODING AUDITOR ** is responsible for auditing inpatient medical records and generating… more
    Elevance Health (07/22/25)
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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Tampa, FL)
    **Diagnosis Related Group Clinical Validation Auditor -RN** **Virtual:** This role enables associates to work virtually full-time, with the exception of required ... granted as required by law. The **Diagnosis Related Group Clinical Validation Auditor -RN** is responsible for auditing inpatient medical records to ensure clinical… more
    Elevance Health (08/01/25)
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  • Clinical Provider Auditor II

    Elevance Health (Tampa, FL)
    …systems/tools to accurately document determinations and continue to next step in the claims lifecycle. + Researches new healthcare related questions as necessary ... **Clinical Provider Auditor II** **Supports the Payment Integrity line of...abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines… more
    Elevance Health (08/01/25)
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  • Provider Auditor (RN/LPN Medical Coder…

    Elevance Health (Miami, FL)
    **Provider Auditor ** _This position will work a hybrid model (remote and office), 1 time per week. The Ideal candidate will live within 50 miles of one of our ... to recover, eliminate and prevent unnecessary medical-expense spending. The **Provider Auditor ** conducts on-site reviews of medical charts, medical notes, itemized… more
    Elevance Health (08/01/25)
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  • Coding Auditor Educator

    Highmark Health (Tallahassee, FL)
    …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
    Highmark Health (05/09/25)
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  • Sr Compliance RCM & Coding Auditor

    Humana (Tallahassee, FL)
    …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
    Humana (07/29/25)
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  • Specialist, Configuration Oversight

    Molina Healthcare (FL)
    …conducting various audits including, but not limited to; vendor, focal, audit the auditor . Confirm that documentation is clear and concise to ensure accuracy in ... auditing of critical information on claims ensuring adherence to business and system requirements of...& ABILIITIES:** + Minimum 2 years as an operational auditor for at least one core operations function +… more
    Molina Healthcare (07/18/25)
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