- Elevance Health (Mason, OH)
- **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 (Mason, OH)
- …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** **Location** **Virtual** : This role enables...abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines… more
- Elevance Health (Mason, OH)
- **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 (Mason, OH)
- …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 (Mason, OH)
- **Provider Auditor -** FRD > Audit **Hybrid 1:** This role requires associates to be in-office **1 - 2** days per week, fostering collaboration and connectivity, ... to recover, eliminate and prevent unnecessary medical-expense spending. The **Provider Auditor ** conducts on-site reviews of medical charts, medical notes, itemized… more
- Highmark Health (Columbus, OH)
- …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
- Bon Secours Mercy Health (Cincinnati, OH)
- …Assists in the review of Bon Secours Mercy Health coding, billing and claims processing policies and procedures for the development of compliance internal monitors ... periodic review and analysis of Bon Secours Mercy Health hospital claims denial reports, operational assessment reports, internal quality control reviews, internal… more
- Molina Healthcare (Columbus, OH)
- …equivalent combination of education and experience **PREFERRED EXPERIENCE:** 3+ years Healthcare Claims Adjudication **PHYSICAL DEMANDS:** Working environment is ... including, but not limited to; vendor, focal, audit the auditor . Confirm that documentation is clear and concise to...to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of… more
- Elevance Health (Mason, OH)
- **PBM Compliance Manager ( Claims Audit)** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, ... is granted as required by law. The **PBM Compliance Manager ( Claims Audit)** is responsible for coordinating pharmacy compliance activities and initiatives… more
- Medical Mutual of Ohio (OH)
- …strategies and goals in alignment with regulatory specification for the annual Healthcare Effectiveness Data and Information Set (HEDIS) lifecycle processes for all ... Advantage, and Medicaid), including HEDIS audit submission, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Survey (HOS).… more