- Elevance Health (Denver, CO)
- …in applicable state(s). + Requires a minimum of 10 years of experience in claims auditing, quality assurance , or clinical documentation improvement, and a ... and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes and audits claims … more
- CVS Health (Hartford, CT)
- … assurance projects. + 5+ years of experience in provider contract testing, claims adjudication systems, quality assurance , or related functions. + 5+ ... with extensive experience in provider and contract testing, test automation, and quality assurance . You will be responsible for managing a team of quality… more
- Chenega Corporation (San Antonio, TX)
- …Minimum three (3) years of experience within the last seven (7) years evaluating disability claims within an Internal Quality Assurance , Office of Quality ... + Participate in special studies and case reviews, reports findings respective Quality Assurance Manager for administrative action. + Assist with program… more
- Sharp HealthCare (San Diego, CA)
- …reasonableness checks). Providing efficient and cost-effective solutions as required.Oversees all claims testing and quality assurance activities and ... and responding to internal and external benefit inquiries, and supporting claims testing activities. Provides training to new and less experienced Benefit… more
- Sharp HealthCare (San Diego, CA)
- …checks) provide efficient, cost-effective solutions as directed.Serve as the lead on claims testing and quality assurance activities and assisting ... investigating and responding to internal and external benefit inquiries, and supporting claims testing activities. **Required Qualifications** + 3 Years in HMO or… more
- AdventHealth (Altamonte Springs, FL)
- …Management, the Physician Advisor is responsible for providing clinical review of utilization, claims management, and quality assurance related to inpatient ... in support of medical management programs, promoting the delivery of high quality , patient focused and cost-effective medical care. **The value you will bring… more
- Legacy Parking Company (Miami, FL)
- …or any unusual occurrence to Management. + Ensure compliance with loss prevention, claims reporting, quality assurance and company's policies and procedures. ... Non-Essential Duties and Responsibilities + Implementation and completion of other projects, programs and initiatives that may be assigned by management Minimum Job Qualifications + High School degree required. + One year related experience. + Ability to read… more
- Legacy Parking Company (Miami, FL)
- …or any unusual occurrence to Management. + Ensure compliance with loss prevention, claims reporting, quality assurance and companies policies and procedures. ... Non-Essential Duties and Responsibilities + Implementation and completion of other projects, programs and initiatives that may be assigned by management Minimum Job Qualifications + One year related experience. + Ability to read and comprehend verbal… more
- LA Care Health Plan (Los Angeles, CA)
- …Services/Population Health department. Advanced knowledge of and experience in health plan quality assurance (especially related to claims , health ... and analytical work related to the testing, validation, and quality assurance of business requirements for and...root causes, etc. that impact member access to care, claims payments, etc.; and assessment and roll-out of key… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Director of Application Support and Quality Assurance will oversee initiatives that align with the strategic goals of the ASG department. This ... to drive business growth, with a strong emphasis on quality control and improvements to enhance claims ...on quality control and improvements to enhance claims processing stability, flexibility, and innovation. The Director will… more
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