- AIG (Miami, FL)
- …Mining in Operation, and Construction (CAR/EAR). + Strong understanding of risk selection process , exposure analysis including BI calculations, CAT ... of services to the organization such as Finance, Internal Audit , Communications, Security and Human Resources. Get to know...Strong understanding of actuarial methods in support of pricing risk , claims and reserving practices. + Advanced… more
- Insight Global (Pleasanton, CA)
- …for outpatient mental health. * Ensure provider documentation supports all billed services. * Audit claims to minimize risk of denials or audits. * ... responsible for the accurate preparation, submission, and reconciliation of Medicare claims for outpatient mental health services. This role ensures compliance with… more
- State of Colorado (Broomfield County, CO)
- …processes. + Support the benefits Administrator to ensure all workers compensation claims are filed with Risk Management/Broadspire within the necessary time ... and enthusiastically serve them. Therefore, in all aspects of the employment process , we provide employment opportunities to all qualified applicants without regard… more
- Highmark Health (Harrisburg, PA)
- …to affected areas. Uses information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and ... OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and… more
- Tenet Healthcare (Commerce Township, MI)
- …maximizes process efficiency and reimbursement. Works with Conifer team on process improvement initiatives for patient access claims , billing and payment ... and DMC/Tenet policies. As directed, implements external and internal audit recommendations. Ensures hospital departments achieve objectives for diversity of… more
- Sedgwick (Dubuque, IA)
- …the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating ... colleagues. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Oversees internal quality review process and reports monthly. + Assures compliance with client internal… more
- East Boston Neighborhood Health Center (East Boston, MA)
- …a focus on contract pharmacy management through 340B ESP, 340B audit preparation, wholesaler drug pricing file accuracy, and ongoing compliance tracking/verification ... + Coordinate 340B ESP contract pharmacy activities, including data submission, audit tracking, and compliance with manufacturer policies to maintain pricing… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …fraud risk and ensuring compliance with regulatory requirements + Maintain process integrity and ensure legitimate claims are processed efficiently + ... monitoring activities + Collaborate with other departments such as Claims , Medical Management, Internal Audit , Recovery and...investigative skills + Proven track record in operations and process improvement + Able to thrive in a complex,… more
- AmeriHealth Caritas (Newtown Square, PA)
- …and other internal/external key stakeholders to ensure regulatory alignment and mitigate audit risk _Provider Support & Stakeholder Engagement_ + Lead the ... engagement strategies that promote transparency and trust throughout the claims auditing process + Act as a...+ Use analytics to proactively identify emerging issues, support audit readiness, and drive continuous optimization + Evaluate and… more
- Lundbeck (Deerfield, IL)
- …employees. Provide support for compliance communications program. + **Field Compliance Risk Mitigation** **:** Identify and implement strategic projects designed to ... aspects of internal investigations, while ensuring legal compliance and managing risk . Partner with the Director, Field Compliance and Investigations to recommend… more