- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …organization. This position will work with multiple other areas including High-Cost Claims , Payment Policy Strategy, Data Mining Audit , Facility Reimbursement, ... Ready to help us transform healthcare ? Bring your true colors to blue. About...responsible for post-pay review to verify the accuracy of claims reimbursement, clinical significance, coding, and billing in accordance… more
- Highmark Health (Lincoln, NE)
- …responsible for assisting in the processing and investigation of non-complex health care claims to determine the legitimacy of claim charges. The incumbent will also ... services and charges; will monitor internal referrals from sources such as claims , customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert… more
- Independent Health (Buffalo, NY)
- …will aid in training other team members, evaluating appeals, and share audit trends across the team. Expertise and proficiency demonstrated by long-standing, ... ability to train others, to identify coding patterns and share knowledge and audit tips across the team. The Clinical & Coding Specialist-Senior will support the… more
- Integra Partners (Troy, MI)
- …legislation. This role serves as an internal subject matter expert on healthcare payer policies to develop and update billing procedures, assist with provider ... Medicaid, and NCQA regulations relevant to Utilization Management (UM), Credentialing and Claims , with the ability to translated them into operational requirements +… more
- State of Georgia (Fulton County, GA)
- …Summary Under the direction of the Fraud Unit Director, assists in healthcare investigations by: reviewing provider and recipient records, by making determinations ... to whether proper diagnostic and procedure codes were used in submitting claims to the Georgia Medicaid Program. Maintains a comprehensive understanding of current… more
- CGI Technologies and Solutions, Inc. (Knoxville, TN)
- …Description:** The OP Coding Auditor is a member of the CGI Healthcare Compliance, Outpatient Coding Team, with responsibility for reviewing medical records to ... in the identification of improper payments (overpayments and underpayments) on paid claims on behalf of the client from various providers of clinical services,… more
- University of Utah Health (Murray, UT)
- …and patient-level data. + Ability to perform complex research and analysis of healthcare claims , enrollment, and other related data, to report on network ... program. + This role is responsible for analyzing medical claims , encounter, and risk adjustment targeting data to identify...in risk adjustment analytics within a health plan or healthcare organization. + Proficiency in SQL and data analysis… more
- WellSpan Health (York, PA)
- …qualified patients, drugs and locations. Monitors and audits state Medicaid claims to ensure compliance to prevent potential duplicate discount rebates. Evaluates ... and improve 340B Program compliance and performance and for compliance and audit purposes. Maintains up-to-date policies and procedures on 340B purchasing processes.… more
- Actalent (West Des Moines, IA)
- …criteria for clearing pending claims based on defined policies and procedures. + Audit and price a wide variety of claim types. + Identify claims with ... CPT, ICD-10, and HCPCS. The Nurse Auditor is responsible for adjudicating claims to comply with client contracts and plan documentation. This includes determining… more
- Covenant Health Inc. (Knoxville, TN)
- …reports every morning. + Follows up on identified deficiencies related to the billing claims audit within 24 hours following receipt of the Billing Claims ... reports every morning. + Follows up on identified deficiencies related to the billing claims audit within 24 hours following receipt of the Billing Claims… more