- Aston Carter (Solon, OH)
- …Job Description The Pricing/Return Coordinator is responsible for ensuring adherence to audit procedures set forth for all price deviations and commissions. For ... in SAP that have the necessary approvals thru the Claims area or the normal Sales channel. This position...blocks on other associate's entries * Create credits for claims approved to be processed out of CRM from… more
- Otsuka America Pharmaceutical Inc. (Columbus, OH)
- …with Sales and Marketing on sample allocation and planning. + Support audit readiness and compliance reviews. **Operational Efficiency & Field Partnership** + ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
- Prime Therapeutics (Columbus, OH)
- …in accordance with procedures or to present to management to recommend for audit or investigation. Serves as a corporate resource on fraud, waste and abuse ... Education Level Bachelors + Experience Level 2+ years + Required Fraud Investigations and Claims experience Must be eligible to work in the United States without the… more
- O'Neal Industries, Inc. (Hamilton, OH)
- …+ Collaborate with supplier and Quality Assurance to document non-conforming claims and promote resolution. + Drives non-conforming inventory resolution through ... when appropriate to Quality Assurance. + Designs and implements supplier audit /assessment process and cadence based on reoccurring concerns. + Performs supplier… more
- Humana (Columbus, OH)
- …Compliance team that supports the PCO is responsibility to assess, investigate, audit and validate the mitigation of compliance risk across the organization. This ... action plans, as needed. You will participate in all phases of the audit process including evaluating control design and adequacy, testing to ensure adherence with… more
- BrightSpring Health Services (Columbus, OH)
- …pharmacy operations and medication distribution, medication, storage and oversight . Audit all aspects of medication storage in the facility/community, including ... stability and labeling. This audit encompasses every area of the medication room, including...service to patients and healthcare providers . Process insurance claims and handle medication inquiries . Ensure inventory control… more
- Humana (Columbus, OH)
- …records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Decisions are typically related to resources, approach, and ... Bachelor's Degree + Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of...CPC, CCS, CFE, AHFI) + Understanding of healthcare industry, claims processing and internal investigative process development + Experience… more
- Molina Healthcare (Akron, OH)
- …software and medical record vendors, and other Molina departments, such as Claims , Enrollment, IT etc,. to get appropriate responses and manage contracts and ... + Maximizes use of information from multiple sources, including claims /encounters, pharmacy, utilization management, clinical indicators, industry benchmark, and/or… more
- Aston Carter (Chagrin Falls, OH)
- …Order Fulfillment Specialist plays a crucial role in ensuring adherence to audit procedures for price deviations and commissions. This position involves updating ... blocks on other associates' entries. + Create credits for claims approved to be processed out of CRM from...approved to be processed out of CRM from the Claims Team. + Enter credit orders in SAP with… more
- Molina Healthcare (Cincinnati, OH)
- …+ Responsible for encounters accuracy & completeness (ie, Encounter Production, Audit , Production Vendor Oversight) for assigned lines of business. Responsible for ... Ability to influence across multiple organizational functions - Payment Integrity, Claims , Encounters, Finance, and Actuarial + Proven experience in managing complex… more