- 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...Audit setting or hospital coding or quality assurance environment preferred . + Broad knowledge of medical claims … 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** **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)
- …communication skills Preferred + Associate's Degree + 3 years with claims processing and data management + Past auditing and strong education/training background ... 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 (Columbus, OH)
- …cycle management (related to billing, coding, collections for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare records + Must ... and regulations governed by the Department of Insurance and CMS ** Preferred Qualifications** + Compliance regulations knowledge and compliance auditing experience +… more
- Molina Healthcare (Columbus, OH)
- …updates/changes within claims processing system . + Experience using claims processing system (QNXT). ** PREFERRED EDUCATION:** Bachelor's Degree or ... including, but not limited to; vendor, focal, audit the auditor . Confirm that documentation is clear and concise to...equivalent combination of education and experience ** PREFERRED EXPERIENCE:** 3+ years Healthcare Claims Adjudication… more
- Medical Mutual of Ohio (OH)
- …This is a fully remote opportunity. Eastern Time Zones preferred .** **Responsibilities** **HEDIS Analyst II** + Coordinates and collaborates interdepartmentally ... To include data documentation, compilation, reconciliation, and research.Works directly external HEDIS/NCQA auditor to resolve any items on Issue Log. + Reviews data… more