- Commonwealth Care Alliance (Boston, MA)
- …user acceptance testing, and analyze post production reports for issues + Support collaboration between PI/ Claims and other internal stakeholders related to ... claims management, coding rules and guidelines, and evaluating/analyzing claim outcome results for accurate industry standard coding logic and policies… more
- Catholic Health Initiatives (Little Rock, AR)
- …processes. Assist in the creation of workflows and guidelines for these new processes. + Support the Risk Auditor Manager of closely working with the HCC Risk ... all things quality and risk for the value hub. + Through Risk Management/ Auditor Manager, implements a risk adjustment coding department in appropriate Arkansas and… more
- Amazon (Seattle, WA)
- …support and ongoing financial and risk analysis. - Support ongoing actuarial support for outside auditor review of financial estimates and results. -Design ... are refreshed monthly and provided quarterly for forecasting and planning - Support month end financial and accounting processes for relevant actuarial estimates.… 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 ... feedback and focused educational programs on the results of auditing, review claim denials pertaining to coding, and implement corrective action plans. Exemplifies… more
- Hartford HealthCare (Farmington, CT)
- …of Connecticut's most comprehensive healthcare network. The creation of the HHC System Support Office recognizes the work of a large and growing group of employees ... the system.*__* *_Position Summary:_* The Quality Revenue Cycle Billing and Auditor Specialist is responsible for ensuring accuracy, compliance, compliance and… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …may include audits designed to review the adequacy of medical record documentation to support claims as well as inquiries into suspected or reported deviation ... services, including coding accuracy, documentation sufficiency, charge capture, modifiers, and claim edits. Audits to be performed are identified based on the… more
- Trinity Health (Albany, NY)
- …ICD-10-CM codes for diagnoses assigned in the EHR by the providers to claims being submitted for their services. Using billing system work queues and natural ... language processing (NLP) tools to support addressing HCC codes for Risk Adjustment before a claim is submitted to payers. + Demonstrate a solid understanding of… more
- Covenant Health Inc. (Knoxville, TN)
- …Analyzes all correspondence regarding insurance denials for the revenue integrity auditor to take appropriate action. Prepares necessary documentation for insurance ... appeals process, ensuring timely follow through. Processes claim adjustments for leadership approval and posts payments as...coordinates insurance appeals. + Provides assistance to auditors and support staff as it relates to front end and… more
- Eaton Corporation (Fayetteville, NC)
- …with warranty claim processing. **In this function you will:** A. Support the analysis and solution of quality problems, disposition of non-conforming material, ... and business considerations. **What you'll do:** The Quality Technician will support the analysis and solution of quality problems, processing/disposition of… more
- MyFlorida (Tallahassee, FL)
- …Insurance, Program Integrity Unit as an Audit Manager and will serve as an auditor and contract manager for the state group insurance program's post payment ... claims audits and the Pharmacy Benefits Manager compliance audit....accuracy. + Prepares clear and concise investigatory reports to support findings of potential fraud, waste and abuse. +… more