- Humana (Harrisburg, PA)
- …of our caring community and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure ... Follows established guidelines/procedures. **Where you Come In** The Medical Coding Auditor reviews medical claims submitted against medical records provided,… more
- AmeriHealth Caritas (Philadelphia, PA)
- …audit process and communicate the audit outcome to the appropriate persons. The auditor will validate production to ensure that the case is migrated appropriately. ... post-implementation review is completed as the policy outlines. The auditor will be expected to build/run complex queries to...will be expected to build/run complex queries to identify claims affected by the configuration change and analyze all… more
- Humana (Harrisburg, PA)
- …evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle ... caring community and help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns… more
- Humana (Harrisburg, PA)
- …caring community and help us put health first** The Inpatient Medical Coding Auditor reviews a variety of medical records and to determine appropriate procedural ... terminology and medical codes (eg, ICD-10-CM, CPT.) The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the… more
- St. Luke's University Health Network (Allentown, PA)
- …to include reviewing medical record documentation for completeness and accuracy to support billed claims . + Generate provider reports through billing software. ... of a patient's ability to pay for health care. The Network Provider Services Auditor performs audits as part of the Documentation and Coding Compliance Program for… more
- Commonwealth of Pennsylvania (PA)
- …leadership of the Office of State Inspector General and the Department of Auditor General. + Direct planning and budgeting for the Audit Risk Management Division. ... CFE, Certified Fraud Examiner + CISA, Certified Information Systems Auditor + CIA, Certified Internal Auditor How...of determining your eligibility for the position. Information to support your eligibility for the position must be provided… more
- UGI Corporation (King Of Prussia, PA)
- …will have a background in corporate governance, real estate and litigation support , with exceptional organizational skills and a proactive approach to legal ... support . The employee is expected to provide paralegal ...assist with drafting corporate resolutions and secretary's certificates. Handle auditor request letters. + Real Estate: Assist on right… more
- St. Luke's University Health Network (Allentown, PA)
- …The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all diagnosis and procedure codes to assure ... and apply appeal arguments and draft appeal letters to support and defend the codes assigned by the coding...made by the government or commercial payors, or their auditor representative. + Facilitate clinical chart reviews to assist… more
- Humana (Harrisburg, PA)
- …Adjustment Operations, including the areas of Provider Data Validation, Provider Support , Provider Reporting, Quality Audit, and risk adjustment operations related ... Bachelor's degree - Accounting, Finance, Business, Auditing, Actuarial + Certified Internal Auditor , CPA or CPC strongly preferred + Risk Adjustment knowledge +… more