- Independent Health (Buffalo, NY)
- …of Independent Health policies and procedures. + Prepare and present audit results as needed, to various levels of internal senior leadership for approval ... will aid in training other team members, evaluating appeals, and share audit trends across the team. Expertise and proficiency demonstrated by long-standing,… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation. + Maintains awareness of fraud, waste and ... creating auditing protocols which align with Bon Secours Mercy Health 's overall compliance audit and compliance responsibilities...+ Assists in the review of Bon Secours Mercy Health coding, billing and claims processing policies… more
- Baylor Scott & White Health (Dallas, TX)
- **About Us** Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest ... to time off benefits At Baylor Scott & White Health , your well-being is our top priority. Note: Benefits...the responsibility of the pricing, configuration, provider data and audit function (the provider data integrity unit). This position… more
- LA Care Health Plan (Los Angeles, CA)
- …execution, reporting and corrective action plans monitoring of financial solvency and claims processing compliance for specialty health plans and vendors. These ... or vendor's management for LA Care vendors. + Performance claims audits for Specialty Health Plans and...for Centers for Medicare and Medicaid Services (CMS) claim audit section of LA Care delegates. + Annually reviews… more
- Magellan Health Services (Somerset, PA)
- …that support achievement of strategic alignment (IT, Finance, Product Development, Claims , Legal etc.). Under guidance, takes the leadership role in coordinating ... + Ensures Service Level Agreement performance, assurance of accuracy of claims payment and administrative policies, rate maximization through ongoing benefit… more
- Highmark Health (Buffalo, NY)
- …Guarantees and other operational quality process improvement efforts. Maintains accurate audit documentation and is required to follow appropriate audit ... and systems within the process being audited. Manage individual inventory of audit work to meet department quality standards. Participate in special project work… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- … systems and QA programs. + Prior background in implementing and managing Health Care Claims systems transformations and optimizations. + Proven results in ... with a strong emphasis on quality control and improvements to enhance claims processing stability, flexibility, and innovation. The Director will be responsible for… more
- Independent Health (Buffalo, NY)
- …seminars and/ or content to all primary care practices associated with Independent Health . The Analyst is responsible for the targeted delivery of information to ... The incumbent is also responsible for assisting in the claims review, medical record capture and review, and identification...verify CMS HCC submission as assigned per CMS RADV audit specifications. The Analyst is going to assist the… more
- Highmark Health (Springfield, IL)
- …This job is responsible for assisting in the processing and investigation of non-complex health care claims to determine the legitimacy of claim charges. The ... services and charges; will monitor internal referrals from sources such as claims , customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …preferred or equivalent experience or training + Minimum of 5 years claims audit /quality assurance experience in healthcare required + Strong understanding ... reconciliation QA audits for BCBSMA's payment integrity programs. + Audit vendor claims data and invoices against...as the highest in member satisfaction among Massachusetts commercial health plans by JD Power , Blue Cross Blue… more