- WTW (Houston, TX)
- **Description** As a Medical Claim Field Auditor , you will apply your medical claims audit, project management and claim processing and auditing ... will serve as a team member on audits, evaluate claims for accuracy and identify potential errors and issues....Claims processing knowledge/exposure to one or more administrator claim systems such as UNET, WGS, NASCO, ACAS, Proclaim,… more
- WTW (Houston, TX)
- **Description** As a Medical Claim Lead Auditor , you will apply your audit, project management and client management skills to lead client audits. You will serve ... administrators. You will review discrepancy issues identified by field auditors, re-adjudicate claims , resolve open issues, and draft the final report. You will… more
- Marshfield Clinic (Marshfield, WI)
- …come together to support the most exciting missions in the world!** **Job Title:** Claims Auditor (Remote - WI or MN) **Cost Center:** 682891379 SHP- Claims ... (United States of America) **Job Description:** **JOB SUMMARY** The Claims Auditor is responsible for performing payment,... has working knowledge of the overall aspects of claim processing, both in and outside of Security Health… more
- US Tech Solutions (Whittier, CA)
- …: Day** **Next Start date: Immediately** **Contract length: 3 months** **POSITION SUMMARY** The Claims Auditor assists in the Claims Department by analyzing ... procedures, policies and reports; ensures appropriate payment of claims and maintenance of the claims system...payment of claims and maintenance of the claims system as necessary. **SPECIFIC SKILLS NEEDED** Knowledge of… more
- UCLA Health (Los Angeles, CA)
- …to the next level. You can do all this and more at UCLA Health. The Claims Quality Auditor will be responsible for the daily audit of all examiners assigned ... to the auditor . You will review claims (paid, pending, and denied) for accuracy, appropriate application of benefits, authorization for services, contract… more
- Cedars-Sinai (Los Angeles, CA)
- …fuels innovation. **Req ID** : 13340 **Working Title** : Outpatient Surgical and Claims Edit Auditor **Department** : CSRC Coding Audit **Business Entity** : ... will I be doing in this role?** The Coding Auditor works under the general direction of the Coding...the general direction of the Coding Supervisor. A Coding Auditor is responsible for reviewing encounters in either a… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure ... claims are processed in accordance with Federal, State and...results to recommend system or procedural changes to increase claim accuracy and/or identify opportunities for workflow enhancements. +… more
- Molina Healthcare (Syracuse, NY)
- JOB DESCRIPTION Job Summary Provides support for claims audit activities including identification of incorrect coding, abuse and fraudulent billing practices, waste, ... overpayments, and claims processing errors. **Essential Job Duties** + Audits the...errors. **Essential Job Duties** + Audits the adjudication of claims using standard principles, and state-specific regulations to identify… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure ... Follows established guidelines/procedures. **Where you Come In** The Medical Coding Auditor reviews medical claims submitted against medical records provided,… more
- UPMC (Pittsburgh, PA)
- …in person or virtual recipient restriction hearings. + Review Medical Pended Queue claims to understand and resolve claim referral issues through research and ... UPMC Health Plan has an exciting opportunity for a Clinical Auditor /Analyst Intermediate! The Clinical Auditor /Analyst Intermediate is an integral part of the… more
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