- Conduent (Los Angeles, CA)
- …be part of a culture where individuality is noticed and valued every day. **Pharmacy Claims Auditor CPhT** **Do you have a CPhT certification?** **Would you like ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a...claim data. This is to ensure billed pharmacy claims are being accurately submitted. You will also be… more
- UCLA Health (Los Angeles, CA)
- …an exciting new direction. You can do all this and more at UCLA Health. The Claims Quality Auditor serves as the primary point of contact for submission and ... reports for the department. Additional responsibilities include: + Reviewing claims for accuracy, appropriate application of benefits, contract interpretation and… more
- Humana (Sacramento, CA)
- …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 (Los Angeles, CA)
- **Diagnosis Related Group Clinical Validation Auditor -RN** **Virtual:** This role enables associates to work virtually full-time, with the exception of required ... onboarding and skill development. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to ensure… more
- Highmark Health (Sacramento, CA)
- ** Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding ... and ensures compliance with DRG/APC structure and regulatory requirements. Performs periodic claim form reviews to check code transfer accuracy from the abstracting… more
- Ross Stores, Inc. (Dublin, CA)
- …nationwide\. With 2023 revenues of $20\.4 billion, we are a Fortune 500 company who is committed to providing an inclusive work environment with continuous learning ... if lease requirements have been met\. Draft and send claim letters\. Calculate and pay Substitute Rent if a...Tie out Landlord receivable balances by isolating overcharges, audit claims , misapplied checks, and unpaid charges\. * Contribute to… more
- Lineage Logistics (Riverside, CA)
- …Weigh or count items for distribution within the plant to determine and ensure meet company standards + Report damages and claims to inventory control + Arrange ... fill customer orders to be shipped while following all regulatory and company safety standards, policies, and procedures. **KEY DUTIES AND RESPONSIBILITIES** +… more
- LA Care Health Plan (Los Angeles, CA)
- …the safety net required to achieve that purpose. Job Summary The Specialty Plans Auditor III is responsible for planning audits and audit work programs that address ... appropriate claims and financial compliance criteria for specialty health plans....position is the liaison in external and or (CMS) claim audits Organization Determination, Appeals & Grievances (ODAG) of… more
- The Walt Disney Company (Burbank, CA)
- …the settling of audit claims and estimates potential future audit claims by preparing audit claim re-calculations, what-if scenario analyses, and ... programs such as subscriptions, and actively assisting in settling audit claims through detailed analyses and presentation decks. The team works closely… more
- CVS Health (Sacramento, CA)
- …passionate about transforming health care. As the nation's leading health solutions company , we reach millions of Americans through our local presence, digital ... all with heart, each and every day. **Position Summary** Claim Audit Quality Analysts need to have a wide...review. A candidate must become subject matter experts in claims , plan documents, eligibility, coverages, and quirks of multiple… more