- LogixHealth (Dania, FL)
- Location: On-Site in Dania, FL This Role: As a Claims Specialist, you will work with internal teams to provide cutting-edge solutions that will directly improve the ... healthcare industry. You'll contribute to our fast-paced, collaborative environment...and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,… more
- Molina Healthcare (Boise, ID)
- …equivalent combination of education and experience **PREFERRED EXPERIENCE:** 3+ years Healthcare Claims Adjudication **PHYSICAL DEMANDS:** Working environment is ... various audits including, but not limited to; vendor, focal, audit the auditor. Confirm that documentation is clear and...to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of… more
- Commonwealth Care Alliance (Boston, MA)
- …(must have): * 5+ years in healthcare compliance, regulatory affairs, or claims audit . * Experience working with TPA partners (eg, Cognizant) and submitting ... 011250 CCA- Claims **_This position is available to remote employees...for ensuring CCA's operational compliance with state and federal healthcare regulations, particularly MassHealth (Massachusetts Medicaid) and CMS Medicare… more
- Guidehouse (San Marcos, CA)
- …is expected to perform all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims . Must work with other ... Billing Emphasis + Correcting and billing electronic and hardcopy claims + Submits Adjusted claims + Provides...or insurance information. + Works all rejection and payer audit reports within 48 hours of receipt taking whatever… more
- Molina Healthcare (Grand Island, NE)
- …SQL and exposure to Python or another programming language + Basic familiarity with healthcare data types such as claims , encounters, or eligibility data + ... Familiarity with Medicare Advantage or Medicaid programs + Awareness of CMS audit processes or healthcare compliance requirements **Ideal Candidate Attributes**… more
- Grant Thornton (Los Angeles, CA)
- As a Healthcare Process Risk Senior Associate, you will get the opportunity to grow and contribute to our clients' business needs by helping them understand their ... The ideal candidate will have exceptional expertise and experience in healthcare providers, specifically hospitals, academic medical centers, and healthcare … more
- Prime Healthcare (Ontario, CA)
- …improve the quality and minimize process cost of Claims for all Prime Healthcare 's self-insured Employee Health Plans. Through in-depth audit and review of ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/196005/vice-president-of-health-plan-operations-and- claims /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime … more
- Grant Thornton (San Francisco, CA)
- …and the overall effectiveness and efficiency of processes. + Oversee internal audit outsourcing and co-sourcing engagements for clients. + Manage the risk ... 4 years of direct experience with diverse life sciences companies or healthcare providers, including hospitals, academic medical centers, healthcare systems, and… more
- LogixHealth (Dania, FL)
- …teams to provide cutting edge solutions that will directly improve the healthcare industry. You'll contribute to our fast-paced, collaborative environment and bring ... issues and appeal if necessary, using software or other resource tools + Prepare audit results and keep department manager current of all findings and audits and… more
- Centene Corporation (Sacramento, CA)
- …and process claim audit observations. + Review and analyze responses to claims audit observations and findings and facilitate corrective action plans. + ... Finance, Healthcare or equivalent experience preferred. + 2+ years claims compliance experience, preferably with State or Federal managed care programs required.… more