• Pharmacy Claims Auditor CPhT

    Conduent (Dallas, TX)
    …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
    Conduent (06/21/25)
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  • Inpatient DRG Quality Auditor

    Humana (Austin, TX)
    …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 (Grand Prairie, TX)
    **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 (Grand Prairie, TX)
    **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
    Elevance Health (07/17/25)
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  • Clinical Provider Auditor II

    Elevance Health (Houston, TX)
    …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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  • Coding Auditor Educator

    Highmark Health (Austin, TX)
    …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 (Austin, TX)
    …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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  • PBM Compliance Manager ( Claims Audit)

    Elevance Health (Grand Prairie, TX)
    **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
    Elevance Health (07/29/25)
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  • Specialist, Configuration Oversight

    Molina Healthcare (Houston, TX)
    …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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  • Compliance Coding And Billing Analyst

    University of Texas Rio Grande Valley (Mcallen, TX)
    …and regulations and UTRGV policies. To review and analyze medical records, claims , and workflow processes to ensure accuracy, completeness, and compliance with ... processes. + Reviews, assesses and analyzes medical records, coding, billing, claims , reimbursements and workflow processes to ensure accuracy, completeness, and… more
    University of Texas Rio Grande Valley (07/11/25)
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