- Centers Plan for Healthy Living (Staten Island, NY)
- Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … more
- Planned Parenthood of Central and Western NY (Rochester, NY)
- Billing Auditor for Shared Services Fully Remote * Rochester, Buffalo, or Syracuse, NY * Revenue Cycle Description Billing Auditor for Shared ServicesBuffalo, ... of PPCWNY's mission and the collaboration with Shared Services, the Billing Auditor evaluates Revenue Cycle outcomes to identify and recommend opportunities for… more
- Humana (Albany, NY)
- …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
- Elevance Health (Latham, NY)
- **Diagnosis Related Group Clinical Validation Auditor -RN** **Virtual:** This role enables associates to work virtually full-time, with the exception of required ... Friday 8AM -5PM (local time) The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to ensure clinical… more
- Amentum (Albany, NY)
- …research on individuals, business entities, and assets. + Analyze large and complex healthcare claims datasets to identify fraud, waste, and abuse patterns. + ... trends and patterns. + Extract and manipulate federal health claims data using CMS tools such as OnePI, STARS,...briefings and written reports to AUSAs on findings from healthcare data analytics. + Support development of internal best… more
- Highmark Health (Albany, NY)
- …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 (Albany, NY)
- …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
- Molina Healthcare (NY)
- …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
- DoorDash (New York, NY)
- …to connect messaging to downstream metrics, from comprehension to NPS to claims behavior. + Brings strong cross-functional leadership and a track record of ... 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