- Conduent (Alexandria, VA)
- …where individuality is noticed and valued every day. **Pharmacist - Claims Auditor /Reviewer (Part-Time)** **Conduent Payment Integrity Solutions** **Are you ... audits on behalf of major healthcare payers. As a **Pharmacist - Claims Auditor /Reviewer** , you'll apply your clinical knowledge and regulatory expertise… more
- Elevance Health (Richmond, VA)
- …** is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company , for all lines of ... **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ __ _This...and documentation purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside… more
- ManpowerGroup (Vienna, VA)
- …and death claims to verify accuracy, completeness, and compliance with company policies and industry regulations. + Analyze claims documentation, including ... Our client, is seeking a Bank and Corporate Owned Life Insurance (BOLI/COLI) Auditor to join their team. As a Bank and Corporate Owned Life Insurance (BOLI/COLI) … more
- Elevance Health (Norfolk, VA)
- …using medical charts, medical notes, and provider contracts. + Verifies dollar amount on claim is correct in claims system and writes report of the findings ... **Provider Auditor ** _This position will work a hybrid model...itemized bills and providers contracts to ensure that a claim is paid in accordance with the contract, provider… more
- Humana (Richmond, VA)
- …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 (Richmond, VA)
- **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 (Richmond, VA)
- **Clinical Provider Auditor II** **Supports the Payment Integrity line of business** _Location:_ **Virtual:** This role enables associates to work virtually ... recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Provider Auditor II** is responsible for identifying issues and/or entities that… more
- Highmark Health (Richmond, VA)
- ** 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
- Humana (Richmond, VA)
- …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
- Elevance Health (Norfolk, VA)
- **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