- NTT DATA North America (Decatur, IL)
- …when executed as part of an overall sourcing strategy. NTT DATA currently seeks a Claims Auditor to join our team for a remote position. 100% Remote, Client ... the right people on board, anything is possible. The quality , integrity, and commitment of our employees have been...of Direct Hire Pay Rate $21-$22/hr **Position Summary:** The Claims Auditor position reports to the Chief… more
- Prime Therapeutics (Springfield, IL)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Pharmacy Claims Auditor - Remote **Job Description** The Pharmacy Claims ... is responsible for the selection and auditing of claims , educating Prime's network pharmacies and driving contract compliance,...year of work experience in an operations, audit or quality assurance environment + Must be eligible to work… more
- WTW (Chicago, IL)
- **Description** As a Lead Auditor you will apply your audit, project management and client management skills to lead client audits. You will serve as the team leader ... will review discrepancy issues identified by field auditors, re-adjudicate claims , resolve open issues, and draft the final report....activities in an accurate and timely fashion + Write quality value-added draft report in a timely manner +… more
- NTT DATA North America (Decatur, IL)
- …we know that with the right people on board, anything is possible. The quality , integrity, and commitment of our employees have been key factors in our company's ... Summary:** The Utilization Management Coordinator reports to the Director of Claims . This position is responsible for coordinating the appeal activities and… more
- Humana (Springfield, IL)
- …looking is an experienced and well-grounded medical coding auditor to quality review the inpatient hospital claims for proper reimbursement, handle provider ... community and help us put health first** In this role, you will conduct quality reviews of coding processes within the Claims Cost Management organization,… more
- Elevance Health (Chicago, IL)
- … AUDITOR ** is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines ... **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ __ _This...AA/AS or minimum of 5 years of experience in claims auditing, quality assurance, or recovery auditing.… more
- Elevance Health (Chicago, IL)
- …applicable state(s). + Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum ... **Diagnosis Related Group Clinical Validation Auditor -RN** **Virtual:** This role enables associates to work...Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes… more
- Highmark Health (Springfield, IL)
- …and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, ... processes as it relates to the DRG/APC and other clinical data quality management factors. With technical direction and assistance from management, designs and… more
- Humana (Springfield, IL)
- …cycle management (related to billing, coding, collections for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare records + Must ... need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel,… more
- Rush University Medical Center (Chicago, IL)
- …each case. **Summary:** As a key role in the Revenue Integrity team, the Auditor & Educator is responsible for conducting reviews of EMR documentation of patient ... organizational skills. **Preferred Job Qualifications:** * Certified Professional Medical Auditor (CPMA) and/or Surgical Coding certifications * Experience working… more