- Centers Plan for Healthy Living (Staten Island, NY)
- …Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure ... claims are processed in accordance with Federal, State and...keep up to date with departmental changes in conducting quality reviews. + Ensure the consistent use of current… more
- Humana (Albany, NY)
- …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
- Boar's Head Brand/Frank Brunckhorst Co., LLC (Brooklyn, NY)
- …required (ie American Society for Quality - Certified Food Safety & Quality Auditor , Certified Supplier Quality Professional and/or able to obtain ... the Boar's Head Audit Team in conducting comprehensive Food Safety and Product Quality audits across a variety of venues, including Food Service Operations, Retail… more
- ManpowerGroup (New York, NY)
- Jefferson Wells is seeking an experienced **Insurance Auditor with Life Claims ** expertise to join our team. The successful candidate will be responsible for ... compliance with company policies, industry standards, and regulatory requirements. The auditor will analyze the claims documentation and processes, identify… more
- Mohawk Valley Health System (Utica, NY)
- SUPV CODING AUDITOR & EDUCATOR Department: MEDICAL GROUP ADMINISTRATION Job Summary The Supervisor Coding Audit and Education is responsible for overseeing medical ... and education initiatives within the Medical Group. This role supervises Coding Auditor & Educators and conducts coding audits, ensuring adherence to national… more
- Highmark Health (Albany, NY)
- …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
- New York State Civil Service (Albany, NY)
- NY HELP Yes Agency Temporary and Disability Assistance, Office of Title Auditor 1 or Trainee 1 or 2 (NYHELPS) Occupational Category Financial, Accounting, Auditing ... workweek allowed? Yes Telecommuting allowed? Yes County Albany Street Address Audit and Quality Improvement 40 North Pearl Street City Albany State NY Zip Code 12243… more
- City of New York (New York, NY)
- …We provide sidewalks, street reconstruction, water mains, sewers, and pedestrian ramps quality infrastructure that is essential for a healthy, resilient city. To ... 4500 payment requests annually. DDC seeks a Capital Payment Auditor to review and process these payment requisitions. To...(in FMS3); and adjust payment voucher(s) due to liens, claims and assignments. The candidate will use the DDC… more
- Healthfirst (NY)
- **Duties and Responsibilities:** + Conduct quality audits of A&G items cases grievances, pre-service appeals, and post service appeals utilizing appropriate sources ... job aids, regulatory requirements, and case documentation including eligibility, claims , authorizations, faxes, and any additional information required to complete… more
- Healthfirst (NY)
- + Conduct quality audits of A&G items including grievances, pre-service appeals, and post service appeals utilizing appropriate sources of information; including ... eligibility, claims , authorizations, service forms, faxes, and any additional information...causes for appropriate classification, trending, and remediation. + Record/track quality assessment scores and provide feedback to reduce errors… more