- Molina Healthcare (NE)
- …combination of education and experience **PREFERRED EXPERIENCE:** 3+ years healthcare Medical claims auditing **PHYSICAL DEMANDS:** Working environment ... hours will be 7am-3:30pm PST M-F** **Job Summary** Responsible for conducting various healthcare Healthcare claim audits including, but not limited to; vendor,… more
- Amergis (Los Angeles, CA)
- …+ Primary Responsibility: OP Claim Edits - Must have extensive experience in this area + Audit HB SDS / Observation cases (may see some ED cases) + Will see a wide ... is dependent on employment status. About Amergis Amergis, formerly known as Maxim Healthcare Staffing, has served our clients and communities by connecting people to… more
- Molina Healthcare (Layton, UT)
- …Lead Analyst, Configuration Oversight to support our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination ... guidance. The ideal candidate will bring deep knowledge of claims adjudication, QNXT system navigation, and strong analytical acumen....+ Assist in developing and refining internal SOPs and audit tools related to COB claim reviews. + Act… more
- Molina Healthcare (Warren, MI)
- …Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management, Certified Professional in Healthcare Quality or other ... schedule) Looking for a RN with experience with appeals, claims review, and medical coding. **Job Summary** Utilizing clinical...to clinical experience + Documents clinical review summaries, bill audit findings and audit details in the… more
- Molina Healthcare (Caldwell, ID)
- …and other guidance to assess compliance and support building regulatory compliance audit procedures. * At the direction of management, coordinates and performs ... with developing the Operational Oversight Work Plan, monitoring and reporting status of audit project tasks, and reporting on overall status of audit projects.… more
- Molina Healthcare (Long Beach, CA)
- **Job Description** **Job Summary** Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage ... benefit interpretation. Monitors and controls backlog and workflow of claims . Ensures that claims are settled in...refers members with special needs to the appropriate Molina Healthcare program per policy/protocol. * Helps with the development… more
- Molina Healthcare (Orlando, FL)
- …trends, payment integrity issues, and process gaps. + Applies understanding of healthcare regulations, managed care claims workflows, and provider reimbursement ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
- GE HealthCare (Chicago, IL)
- …Insurance & Corporate Risk Manager plays a key role in executing GE HealthCare 's global risk management strategy. This position is responsible for managing insurance ... program operations, claims oversight, and compliance activities. Operating with autonomy within...and work closely with the Risk Management Team. GE HealthCare is a leading global medical technology and digital… more
- Grant Thornton (Los Angeles, 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
- CommonSpirit Health (Englewood, CO)
- …proven track record of success in managing complex data environments and experience with healthcare claims and utilization datasets. If you are a motivated and ... user engagement through post-implementation evaluation **Preferred Experience** + Working knowledge of healthcare claims and remit data + Working knowledge of… more