- Axis (Chicago, IL)
- …part in the selection process. **Job Description** AXIS is seeking a **_Senior Claims Specialist - Environmental Claims_** to join our North America Claims . ... should possess the ability to handle primary & excess claims arising from policies issued to AXIS Environmental insureds....claim trends + Leading and participating in claim audits, audit wrap up meetings, and formal result reporting +… more
- Insight Global (South Jordan, UT)
- …chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical ... systems with a high level of proficiency to make audit determinations and generate audit letters. Maintains...MS-DRG, AP-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines,… more
- Walworth County (Elkhorn, WI)
- …accordance with accounting guidelines, County policies, State statutes, legal compliance, audit compliance and in supporting County department heads related to ... State and other agencies for DHHS services, managing the claims process to maximize reimbursement. Timely prepares all monthly,...the DHHS domain and to ensure compliance with single audit guidelines. Serves as the DHHS liaison with external… more
- Option Care Health (Bannockburn, IL)
- …actions. Partners with other functional areas and field teams to coordinate audit and monitoring activities from initiation through completion of corrective action. ... assessments and workplans. + Coordinates with internal stakeholders to identify audit objectives, scope, and methodologies, and ensure alignment with organizational… more
- The County of Los Angeles (Los Angeles, CA)
- SENIOR NURSING INSTRUCTOR (EMERGENCY MEDICAL SERVICES) Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/3309230) Apply SENIOR NURSING ... INSTRUCTOR (EMERGENCY MEDICAL SERVICES) Salary $122,010.72 - $182,634.24 Annually Location Los...the Quality Improvement program for these sections. + Reviews audit and monitoring tools on an on-going basis to… more
- Beth Israel Lahey Health (Burlington, MA)
- …documentation in order to determine appropriate coding and initiate corrected claims and appeals. Duties include hands-on coding, documentation review, and other ... annually or as introduced or required. 3. Reviews and analyzes rejected claims and patient inquiries of professional services, and recommends appropriate coding… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …professional and ancillary claims . + Minimum 3 years in auditing of claims adjudication. + Working knowledge of medical terminologies and coding a plus ... Analyst, who will oversee contract and benefit configuration to ensure accurate claims processing and network compliance. This is a remote role. Primary… more
- Beth Israel Lahey Health (Burlington, MA)
- …provider documentation in order to determine appropriate coding and initiate corrected claims and appeals. Duties include hands on coding, documentation review and ... annually or as introduced or required. 3. Reviews and analyzes rejected claims and patient inquiries of professional services, and recommends appropriate coding… more
- Medical Mutual of Ohio (OH)
- Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million ... business (Commercial, Marketplace, Medicare Advantage, and Medicaid), including HEDIS audit submission, Consumer Assessment of Healthcare Providers and Systems… more
- UPMC (Pittsburgh, PA)
- … records for Hierarchical Condition Category (HCC) diagnosis codes for focused claims reviews and government audits. Performs medical records reviews, and ... + Ensuring the member's HCC(s) are supported within the member medical records for the specified audit period or review time frame. + Participate in government… more