- CVS Health (Phoenix, AZ)
- …a specialized team of auditors as part of CVS Caremark's extensive Pharmacy Audit division. The Medicare Pharmacy Claims Auditor will administer assigned ... Medicare Part-D Compliance Audit Programs, review pharmacy submitted Medicare claims , make independent decisions, and call network pharmacies to audit … more
- AutoZone, Inc. (Memphis, TN)
- **Job Description** As a **Sr. Audit Recovery Auditor** , you will Utilize analytical and forensic email review skills to audit Merchandising negotiations to ... and communicate flawlessly with Merchandising and Vendors to successfully resolve claims and recover all vendor funding dollars due AutoZone. **Responsibilities**… more
- Ford Motor Company (Albany, NY)
- …for the balance of the book . Proactively monitor key underwriting and claims metrics to identity emerging risks and opportunities . Collaborate with underwriting ... strategic decisions, or adoption of best practices . Manage internal and external audit procedures **UW Audit Process:** . Manage overall underwriting audit… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …case planning and research, conducting onsite or desk audits, clinical reviews of medical records to ensure correct billing of services and appropriateness of care, ... Level I + Functions as a clinical reviewer of medical records, researching and investigating complex medical ...and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. +… more
- Sedgwick (Chicago, IL)
- …achieves appropriate quality audit scores. + Acts as clinical resource to claims examiners to provide guidance on the medical management of claims ... FUNCTIONS and RESPONSIBILITIES** + Performs standard clinical reviews of referred medical claims based on client requirements to ensure accurate and sufficient… 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 ... not eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical… more
- Sedgwick (Indianapolis, IN)
- …& Insurance Internal auditor **PRIMARY PURPOSE OF THE ROLE:** To perform internal audit procedures under the general direction of the Internal Audit Senior; ... to conduct walk-throughs for processes; to assist in preparation of internal audit reports and audit programs. **ESSENTIAL RESPONSIBILITIES MAY INCLUDE** +… more
- Elevance Health (Mendota Heights, MN)
- … chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise, ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… more
- Heath System Services (Niagara Falls, NY)
- …growth! As an intern, you'll get hands-on experience with Revenue Cycle and Medical Records, supporting billing operations, assisting with audit requests, and ... payer or reason code for trend analysis. Billing & Claims Management + Review claim submissions for accuracy and...audit response log. + Support communication between Billing, Medical Records, and Intake teams. Process Improvement Projects +… more
- Beth Israel Lahey Health (Charlestown, MA)
- …Prepare appeal requests as appropriate. * Responsible for appealing and defending claims denials, adverse audit results, and sanctions. * Analysis, tracking, ... appeals relevant to the audits in order to prove medical necessity and level of care were warranted in...fraud or abuse, as necessary. * Appeal and defend claims denials, adverse audit results, and sanctions.… more