- Highmark Health (Harrisburg, PA)
- …(Outpatient): Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA) + 5 years with hospital or ... **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Performs...internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of… more
- AutoZone, Inc. (Little Rock, AR)
- **Job Description** As a **Sr. Audit Recovery Auditor ** , you will Utilize analytical and forensic email review skills to audit Merchandising negotiations to recover ... 3rd Party vendors to recover less than 10% behind Senior Auditor . Negotiate and communicate flawlessly with Merchandising and Vendors to successfully… more
- St. Luke's University Health Network (Allentown, PA)
- …care in the communities we serve, regardless of a patient's ability to pay for health care. The Network Provider Services Auditor performs audits as part of the ... JOB DUTIES AND RESPONSIBILITIES: + Perform quality audits to include reviewing medical record documentation for completeness and accuracy to support billed claims… more
- TEKsystems (Honolulu, HI)
- QNXT quality 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...for this temporary role may include the following: * Medical , dental & vision * Critical Illness, Accident, and… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …Time.* **Essential Job Functions** + Assists in the review of Bon Secours Mercy Health coding, billing and claims processing policies and procedures for the ... . + Coordinates periodic review and analysis of Bon Secours Mercy Health hospital claims denial reports, operational assessment reports, internal quality… more
- TEKsystems (Honolulu, HI)
- Description Key Responsibilities + Claims Auditing: + Reviewing medical claims to verify accurate coding, correct benefit payments, and adherence to contract ... policies. + Issue Resolution: + Investigating and resolving discrepancies in claims payments and identifying underlying system or benefit inaccuracies. + Compliance… more
- Humana (Phoenix, AZ)
- **Become a part of our caring community and help us put health first** CenterWell Senior Primary Care (PCO) is a growing provider organization that currently ... cycle management (related to billing, coding, collections for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare records + Must… more
- TEKsystems (San Bernardino, CA)
- …insurance companies, government payers, third party payers, worker's compensation payers, medical groups, outside hospitals, and physician's offices to ensure timely ... as needed. Will work with follow up on commercial claims and overpayments/underpayments, refunds, auditing, and contract review. Pay...for this temporary role may include the following: * Medical , dental & vision * Critical Illness, Accident, and… more
- CVS Health (Scottsdale, AZ)
- …submitted through the CVS Health claims processing systems. The Pharmacy Claims Auditor will identify and rectify claim inaccuracies that would result in ... At CVS Health , we're building a world of health...stay well in body, mind and spirit. The Pharmacy Claims Reviewer is responsible for reviewing pharmacy claims… more
- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will ... (CPC) + Certified Inpatient Coder (CIC) + Certified Professional Medical Auditor (CPMA) **Desired Education (nice to...Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for… more