- 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
- Insight Global (Los Angeles, CA)
- …and quarterly reporting (eg, MTR, OMT). Conduct oversight of delegates and subcontracted claims processors. We are a company committed to creating inclusive ... Insight Global is looking for a Sr. Financial Compliance Auditor for one of the largest health systems in...person will be responsible for for conducting audits of claims processed by medical groups and health plans contracted… more
- Prime Therapeutics (San Diego, CA)
- …passion and drives every decision we make. **Job Posting Title** Onsite Pharmacy Auditor (based in California) **Job Description** The Onsite Pharmacy Auditor ... pharmacy audits and is responsible for the selection and auditing of claims , educating Prime's network pharmacies and driving contract compliance, and supporting… 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 (Walnut Creek, CA)
- **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
- 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
- Insight Global (Burbank, CA)
- …benefits used. - Prepare files for referral to Trust Counsel and refer compensation claims to the client. - Process monthly internal reports and create work reports ... customer service through phone and email correspondence and promote company culture. We are a company committed...and promote company culture. We are a company committed to creating inclusive environments where people can… more
- Humana (Sacramento, CA)
- …cycle management (related to billing, coding, collections for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare records + Must ... for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its… more
- DoorDash (San Francisco, CA)
- …team at DoorDash is responsible for all things corporate insurance at the company . We are a rapidly growing and exciting function that helps DoorDash manage ... risk and safety with a close lens on the company 's bottom line. We are looking for forward thinkers that are excited to help build out this team and match our… more
- DoorDash (San Francisco, CA)
- …business by managing corporate insurance programs and mitigating risk across Actuarial, Claims Operations, and Risk Management & Mitigation. We operate at the ... Strategy - Beyond risk assessment, you'll help define our company 's risk management approach, ensuring long-term success. + Stay...The Covey tool has been reviewed by an independent auditor . Results of the audit may be viewed here:… more