• Vice President, Payment Integrity

    Centene Corporation (Austin, TX)
    …anywhere in the Continental United States. **Position Purpose:** Direct and oversee claims audit operations and medical code editing scenarios. Oversee payment ... years of Managed Care or CMS related experience, including compliance, claims , payment integrity, or special investigation experience required. + Previous management… more
    Centene Corporation (08/24/25)
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  • Clin Supv-HC

    Covenant Health Inc. (Knoxville, TN)
    …reports every morning. + Follows up on identified deficiencies related to the billing claims audit within 24 hours following receipt of the Billing Claims ... Held Reports. + Oversees the Notification of Missed Visits and submits to physicians. + Acts as a backup and resource for the Patient Services Coordinator in rescheduling missed and declined visits, and processing reassigned and rescheduled requests to ensure… more
    Covenant Health Inc. (06/25/25)
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  • Bank and Corporate Owned Life Insurance…

    ManpowerGroup (Vienna, VA)
    …payment. + Identify and investigate potential fraud, discrepancies, or irregularities in claims processing. + Provide detailed audit findings and recommendations ... with regulatory requirements, including state and federal laws governing life insurance claims . + Develop and maintain audit checklists, procedures, and reports… more
    ManpowerGroup (07/16/25)
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  • Contract Compliance Assistant

    WestCare Foundation (Henderson, NV)
    …reports to the management team on a defined basis + Handle CARF Service Claims Audit reports quarterly including facility reports to Billing Supervisor. + ... Conduct supportive administrative assistant-type duties as needed + Embrace and embody the mission, vision, guiding principles, clinical vision and goals of WestCare Foundation; and + Perform all other duties as assigned. Qualifications Essential… more
    WestCare Foundation (07/10/25)
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  • Compliance Specialist

    Shinda Management Corporation (Queens Village, NY)
    …required processing and reviewing EIV reports/corrections, repayment agreements, and process special claims + Pre- audit LIHTC/HUD and HOME tenant files for all ... of HOME Annual Owner Certifications + Centralize and maintain LIHTC tenant files for audit ready purposes + Perform in-house audits as needed + Prepare reports as… more
    Shinda Management Corporation (09/03/25)
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  • Data Management Strategy & Governance Senior…

    The Cigna Group (Plano, TX)
    …and data informatics and data exchange using healthcare and clinical data such as Claims , Membership, Audit , Client Structure, and Benefits. If you will be ... using Tableau and Looker to create dashboards for campaigning and other internal audit reports; using Python to understand the ETL workflow; using ServiceNow to… more
    The Cigna Group (07/30/25)
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  • Workforce Absence Team Lead

    Sedgwick (Southfield, MI)
    …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, provide training, and monitor… more
    Sedgwick (08/23/25)
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  • Accountant

    Access: Supports For Living (Middletown, NY)
    …independently + Performs A/R, cash/denial postings, and billing/follow up on MCO insurance claims + Completes external audit work as assigned and assists with ... Independently work with spreadsheets and databases. You will assist in internal audit functions, year-end projections, and perform other duties as assigned. PRIMARY… more
    Access: Supports For Living (08/22/25)
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  • Provider Reimbursement Adm-Certified Professional…

    Elevance Health (Houston, TX)
    …claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. + Prepares correspondence to providers ... eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing… more
    Elevance Health (09/04/25)
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  • Data Science Analyst III - Pharmacy Reporting…

    Mount Sinai Health System (New York, NY)
    …Support 340B program reporting by building custom reports, identifying eligible encounters/ claims , and automating audit -ready documentation. + Collaborate with ... and accurate integration of data from various external sources, including wholesalers, claims systems, and financial platforms. + Develop complex SQL logic to join,… more
    Mount Sinai Health System (07/30/25)
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