- Novant Health (NC)
- …Strategy will lead payer accountability and manage contract performance and the defense audit team. This role is critical in ensuring the optimization of revenue ... Management: Provide strategic direction and leadership to the payer strategy and defense audit team, ensuring alignment with the overall goals of the revenue cycle… more
- The County of Los Angeles (Los Angeles, CA)
- …developing and implementing the Quality Improvement program for these sections. + Reviews audit and monitoring tools on an on-going basis to ensure applicability and ... revises these tools and/or develops new audit tools. + Performs administrative work related to role...work related to role as Emerging Infectious Disease and Healthcare Recovery and Business Continuity Program Manager. + Participates… more
- Baystate Health (Springfield, MA)
- …requirements. Data Analysis: Experience in data analysis and the ability to interpret healthcare utilization data, claims data, and financial reports is often ... settlements 3) Will advise and support budgeting, month-end close, regulatory changes, and audit adjustments related to Medicare and Medicaid 4) As a Sr. Managed… more
- Novant Health (Charlotte, NC)
- …team member, we ensure a strong organization capable of providing remarkable healthcare to our patients, families and communities. Therefore, we invite applicants ... Year / Bachelors Degree, required. Degree in Business Administration with a Healthcare of Finance concentration, or equivalent, Health Care Administration, or a… more
- Elevance Health (Chicago, IL)
- …five functional PI areas (Data Mining, Coordination of Benefits, Complex and Clinical Audit , Claims Edits, and the Special Investigations Unit) operating as an ... new targets. Our ideal candidate will have expertise in healthcare process improvement and operational excellence, encompassing planning, assessment, project… more
- Carle Health (Urbana, IL)
- …improve revenue cycle activities for prior authorizations, documentation, billing and claims . Understands regulatory and third party payer guidelines for admissions, ... operations for registration and authorizations. Qualifications **Certifications:** + Certified Healthcare Access Manager (CHAM) within 2 years **Education:** +… more
- Centene Corporation (Sacramento, CA)
- …on workplace flexibility. **Position Purpose:** Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and ... executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse. + Conduct investigations of potential waste,… more
- Prime Therapeutics (Tallahassee, FL)
- …in accordance with procedures or to present to management to recommend for audit or investigation. Serves as a corporate resource on fraud, waste and abuse ... to find suspicious patterns and outliers using knowledge of healthcare coding conventions, fraud schemes, and general areas of...Experience Level 2+ years + Required Fraud Investigations and Claims experience Must be eligible to work in the… more
- BronxCare Health System (Bronx, NY)
- Overview Conduct review of denied claims and audits of registration/insurance verification activities to improve denial rates and enhance revenue. In-service staff ... on Insurance identification/verification and reporting. When directed, audit duties are under the direction of Compliance Program. Responsibilities - Establish and… more
- TEKsystems (Honolulu, HI)
- …auditor reviews and tests the configuration and performance of the QNXT platform, a healthcare claims and benefits management system. The role is crucial for ... ensuring accurate claims processing, regulatory compliance, and overall system integrity. Key...regulatory compliance, and overall system integrity. Key responsibilities + Audit and testing: Conduct regular audits and assessments of… more