- The Cigna Group (Detroit, MI)
- …resource for less-experienced team members and work on special projects as needed. The Auditor role will support the Sr. Manager- Audit on some escalated issues ... The Pharmacy Auditor is responsible for identifying pharmacy audit risks...informed, objective assessment of the accuracy and legitimacy of claims audited. + Utilize personal knowledge of medications and… more
- Marshfield Clinic (Marshfield, WI)
- …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
- Centers Plan for Healthy Living (Staten Island, NY)
- …teams to match the unique strengths of each individual, tiered roles to support the advancement, and with opportunities for cross-training and education, CPHL is the ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … 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
- City of New York (New York, NY)
- …of Medicaid Providers. Utilize standard audit procedures examine records and documents that support claims submitted to Medicaid for reimbursement for goods or ... Job Description APPLICANTS MUST BE PERMANENT IN THE MANAGEMENT AUDITOR CIVIL SERVICE TITLE OR BE PERMANENT IN A COMPARABLE TITLE ELIGIBLE FOR 6.1.9 TITLE CHANGE. IF… more
- Rush University Medical Center (Chicago, IL)
- …each case. **Summary:** As a key role in the Revenue Integrity team, the Auditor & Educator is responsible for conducting reviews of EMR documentation of patient ... feedback and focused educational programs on the results of auditing, review claim denials pertaining to coding, and implement corrective action plans. Exemplifies… more
- Humana (Columbus, OH)
- …evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle ... caring community and help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns… more
- AmeriHealth Caritas (Philadelphia, PA)
- …audit process and communicate the audit outcome to the appropriate persons. The auditor will validate production to ensure that the case is migrated appropriately. ... post-implementation review is completed as the policy outlines. The auditor will be expected to build/run complex queries to...will be expected to build/run complex queries to identify claims affected by the configuration change and analyze all… more
- Molson Coors Beverage Company (Milwaukee, WI)
- …with indirect tax audits as requested, including compilation of documents requested by auditor . + Support the multistate team with miscellaneous projects as ... processing Sales and Use tax returns, providing guidance and support to sales and use tax inquiries, providing technical...in the Vertex software, as well as processing Distributor claims . This position reports to the GBS Record to… more