- Centers Plan for Healthy Living (Staten Island, NY)
- …including basic analysis of identified trends. + Analyzes audit results to recommend system or procedural changes to increase claim accuracy and/or identify ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … more
- New York State Civil Service (Rochester, NY)
- NY HELP Yes Agency Taxation & Finance, State Title Auditor 1 (Tax)/ Auditor Trainee 1 (Tax)/ Auditor Trainee 2 (Tax) (Audit Division) (NY HELPS) Occupational ... City Rochester State NY Zip Code 14604 Duties Description Auditor 1 (Tax) performs on-site field audits and examinations...and advocate disputed cases at BCMS conferences and Small Claims Hearings. May participate at hearings as a witness… more
- New York State Civil Service (White Plains, NY)
- NY HELP Yes Agency Taxation & Finance, State Title Auditor 1 (Tax)/ Auditor Trainee 1 (Tax)/ Auditor Trainee 2 (Tax) (NY HELPS) Criminal Investigations ... authority;.Represent CID and advocate disputed cases at BCMS conferences and Small Claims .Hearings; may participate at hearings as a witness for the Department… more
- Humana (Albany, NY)
- …evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle ... help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical...the accuracy of provider contract payments in our payer systems , and by ensuring correct claims payment… more
- Northwell Health (Lake Success, NY)
- **Req Number** 172252 Surgical Anesthesia Compliance AuditorCompliance Auditor MUST HAVE CPC CERTIFICATON This is a HYBRID position- MUST be in the office located in ... Chappaqua, NY 3 days a week. Surgical Anesthesia Compliance Auditor - Hybrid position- Chappaqua, NY- $100K-$115K Are you passionate about healthcare compliance and… more
- Healthfirst (NY)
- …of provider claims , pre-payments and post-payments including high-dollar and specialized claims across multiple lines of business, claim types and products. ... operational needs. + Assist with performing User Acceptance Testing (UAT) on system enhancements or corporate projects in partnership with Business Operations +… more
- City of New York (New York, NY)
- …submit approximately 4500 payment requests annually. DDC seeks a Capital Payment Auditor to review and process these payment requisitions. To process these ... (in FMS3); and adjust payment voucher(s) due to liens, claims and assignments. The candidate will use the DDC...assignments. The candidate will use the DDC automated ledger system to record and track payments. The successful candidate… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …ICD10, DRG, APC, RBRVS, etc.). + Extensive experience with claims processing systems , claims flow, adjudication process, system edits and display ... in a clear and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. + Manages cases as assigned,… more
- Trinity Health (Albany, NY)
- …providers to claims being submitted for their services. Using billing system work queues and natural language processing (NLP) tools to support addressing HCC ... High School Diploma or GED **ESSENTIAL FUNCTIONS:** Meets Health System 's Guiding Behaviors and Caring Standards including interpersonal communication...codes for Risk Adjustment before a claim is submitted to payers. . Demonstrate a solid… more
- Warner Music Group (New York, NY)
- …the contractually-defined scope) of the audit concerned; + Review and analyze the audit claims submitted by the auditor in question, as well as the relevant ... including, without limitation, tracking audit notifications, reviewing and analyzing the claims contained in the audit reports we receive, making recommendations to… more