- Highmark Health (Nashville, TN)
- …OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and ... identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external … more
- WMCHealth (Valhalla, NY)
- …up and maintained. + Software & Data Management + Maintain, test, and audit split-billing software and associated data feeds, ensuring accuracy and compliance. + ... Develop and refine claims qualification logic and data feeds for contract pharmacy...& Compliance Oversight + Develop and maintain a 340B audit compliance program, executing self-audits and implementing corrective action… more
- 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 ... systems, and other vendor sources. A strong understanding of pharmacy workflows, healthcare finance, and medication data is essential, as this position supports… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in a clear and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. + Manages cases as assigned, ... + Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of… more
- Elevance Health (Indianapolis, IN)
- … claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. + Perform pre-adjudication claims reviews ... eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing… more
- Highmark Health (Montgomery, AL)
- …for proactive and investigative purposes to comply with internal audit and regulatory requirements. **ESSENTIAL RESPONSIBILITIES** + Performs investigations into ... Credentialing or Medical Review Committee. + Engages in delivery of audit results and overpayment negotiations.Responsible for recovery/ savings of misappropriated… more
- Elevance Health (Roanoke, VA)
- …and prevent unnecessary medical-expense spending. The Manager of DRG Coding Audit & Clinical Validation leads a high-performing team responsible for auditing ... **How you will make an impact:** + Sets the strategic direction for audit methodologies, oversees team development, and ensures that audits meet the industry's best… more
- Centene Corporation (Frankfort, KY)
- …in managed care environment, medical provider office, customer service within a healthcare organization, and medical claims . Knowledge of health care, managed ... up accurately in the provider information system for state reporting, claims payment, and directories. Responsible for multiple state deliverables, network reporting… more
- Stony Brook University (East Setauket, NY)
- … healthcare decision support, patient accounting, contract management and/or claims scrubber systems. + Proficiency with SAP Business Objects, Crystal Reports. ... Analyst may include the following, but are not limited to:** + Analyze claims and remittance data and present findings to departmental leadership. + Complete… more
- Movn Health (CA)
- …Senior Medical Biller & A/R Specialist to take full ownership of claims processing and accounts receivable recovery. This is a hands-on, senior-level role ... payer systems is essential. Functional Responsibilities + Submit clean claims via EHR to all payers within 24 hours...+ Maintain accurate billing records and correspondence logs for audit -readiness + Support junior billing staff with training and… more