- Elevance Health (Mason, OH)
- …claim identification, and documentation purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside of the concept ... **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ __ _This...auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all… more
- Elevance Health (Independence, OH)
- …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 (Columbus, OH)
- …of our caring community and help us put health first** The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation ... is complete, compliant and accurate to support optimal reimbursement. The Nurse Auditor 2 work assignments are varied and frequently require interpretation and… 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)
- **Clinical Provider Auditor II** **Supports the Payment Integrity line of business** **Virtual:** This role enables associates to work virtually full-time, with the ... recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Provider Auditor II** is responsible for identifying issues and/or entities that… more
- Elevance Health (Mason, OH)
- **Clinical Provider Auditor II** **Virtual:** This role enables associates to work virtually full-time, with the exception of required inperson training sessions, ... recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Provider Auditor II i** s responsible for identifying issues and/or entities that… more
- Highmark Health (Columbus, OH)
- …and ensures compliance with DRG/APC structure and regulatory requirements. Performs periodic claim form reviews to check code transfer accuracy from the abstracting ... and research related to special projects and providing coverage for coding manager (s). (10%) + Depending on location provides or arranges for education/training of… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …clinical and operational excellence. **Summary** Works collaboratively with the Compliance Manager on creating auditing protocols which align with Bon Secours Mercy ... Assists in the review of Bon Secours Mercy Health coding, billing and claims processing policies and procedures for the development of compliance internal monitors… more
- Elevance Health (Mason, OH)
- …of utilization and/or fraudulent activities by health care providers through prepayment claims review, post payment auditing, and provider record review. **How you ... potential fraud and over-utilization by performing medical reviews via prepayment claims review and post payment auditing . Correlates review findings with… 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 ... is granted as required by law. The **PBM Compliance Manager ( Claims Audit)** is responsible for coordinating...and Client) audits and responds to findings. + Analyze auditor results and findings. + Responsible for client implementation… more
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