• Senior Nurse Auditor - Payment Integrity…

    Elevance Health (Mason, OH)
    …of utilization and/or fraudulent activities by health care providers through prepayment claims review, post payment auditing, and provider record review. **How you ... fraud and over-utilization by performing medical reviews via prepayment claims review and post payment auditing . Correlates review...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
    Elevance Health (07/30/25)
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  • Sr Compliance RCM & Coding Auditor

    Humana (Providence, RI)
    …for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare records + Must be able to work core business hours on EST time between ... of compliance risk across the organization. This team ensures that healthcare providers align their operational practices with legal requirements while fostering… more
    Humana (07/29/25)
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  • Coding Auditor Professional - Remote…

    McLaren Health Care (Shelby Township, MI)
    …and efficiency in physician documentation, code assignment, data collection, and claims processing. 3. Performs retrospective, random, and focused audits of coding ... _Required:_ * Associate degree in HIT, Applied Science, Liberal Arts or related healthcare field * 1 year evaluation and management (E&M) coding experience in any… more
    McLaren Health Care (06/04/25)
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  • Medicare/Medicaid Claims Editing Specialist

    Commonwealth Care Alliance (Boston, MA)
    …Summary:** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will ... 011250 CCA- Claims Hiring for One Year Term **_This position...+ Certified Inpatient Coder (CIC) + Certified Professional Medical Auditor (CPMA) **Desired Education (nice to have):** + Masters… more
    Commonwealth Care Alliance (05/28/25)
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  • PBM Compliance Manager ( Claims Audit)

    Elevance Health (Norfolk, VA)
    **PBM Compliance Manager ( Claims Audit)** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, ... is granted as required by law. The **PBM Compliance Manager ( Claims Audit)** is responsible for coordinating pharmacy compliance activities and initiatives… more
    Elevance Health (07/29/25)
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  • Specialist, Configuration Oversight

    Molina Healthcare (NY)
    …conducting various audits including, but not limited to; vendor, focal, audit the auditor . Confirm that documentation is clear and concise to ensure accuracy in ... auditing of critical information on claims ensuring adherence to business and system requirements of...& ABILIITIES:** + Minimum 2 years as an operational auditor for at least one core operations function +… more
    Molina Healthcare (07/18/25)
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  • Manager Special Investigations Pharmacy Unit

    AmeriHealth Caritas (Newtown Square, PA)
    …Investigations Unit (SIU) will lead efforts to detect, investigate and prevent healthcare fraud within the pharmacy operations. ; This role combines subject matter ... must have the ability to determine correct coding, review claims , medical records and billing data from all types...medical records and billing data from all types of healthcare providers for aberrant billing patterns. ;Duties include managing… more
    AmeriHealth Caritas (08/02/25)
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  • Compliance Coding And Billing Analyst

    University of Texas Rio Grande Valley (Mcallen, TX)
    …and regulations and UTRGV policies. To review and analyze medical records, claims , and workflow processes to ensure accuracy, completeness, and compliance with ... processes. + Reviews, assesses and analyzes medical records, coding, billing, claims , reimbursements and workflow processes to ensure accuracy, completeness, and… more
    University of Texas Rio Grande Valley (07/11/25)
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  • DCT Revenue Cycle Quality Assurance Analyst…

    State of Minnesota (Vadnais Heights, MN)
    …key areas of the revenue cycle, including billing, coding, insurance verification, and claims processing. The goal is to identify areas of improvement and ensure ... internal teams to ensure the organization complies with all relevant healthcare regulations, payer-specific requirements, and internal policies. + Prepare and… more
    State of Minnesota (07/25/25)
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  • Engineering Manager, Dasher Insurance

    DoorDash (Sunnyvale, CA)
    …and safety alerts, provide instant support when incidents occur, and streamline claims through automated processes-all while gathering invaluable data that makes our ... 29, 2024. The Covey tool has been reviewed by an independent auditor . Results of the audit may be viewed here: Covey (https://getcovey.com/nyc-local-law-144)… more
    DoorDash (07/25/25)
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