- Lyric (Newtown Square, PA)
- … editing solution, as a payment, reimbursement or medical policy analyst, medical claims processor, chart auditor /reviewer, or claims edit/denial management ... leadership skills to guide their team in delivering superior claims edits. The Senior Manager will meet regularly with...subject matter expert on CPT, HCPCS, ICD10CM coding and claims edit logic (including NCCI, LCDs, State Medicaid, MUEs,… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …serve through our Healthsource blog: https://healthsource.premera.com/ . The **Medical Coding Auditor ** plays a crucial role in ensuring the accuracy and compliance ... leveraging a deep understanding of ICD-10 and other coding standards, the auditor reviews and researches provider diagnostic coding issues, performs detailed medical… more
- Munich RE (Princeton, NJ)
- Associate Auditor We are adding to our diverse team of experts and are looking to hire those who are committed to building a culture that enables the creation of ... The Opportunity Future focused and always one step ahead! The Associate Auditor will assist in audits/reviews of ceding companies to evaluate compliance with… more
- Selective Insurance (Hartford, CT)
- …all subcontractor operations and detail exposures according to manual rules. Verify claims data. Determine and/or develop premium basis and classification. All in ... regulations. Manage and schedule territory and inventory to optimize efficiencies, auditor expectations and meet internal and external customer needs. Responsible… more
- Spectraforce Technologies (Columbia, SC)
- Role Name: Quality Medical Auditor Location: Columbia, SC 29223 Work Environment: Onsite/ Remote (Preferred Onsite) Schedule: Mon - Fri, 8AM-4:30PM Contract length: ... a healthcare setting) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves as a… more
- Argonaut Management Services, Inc (Chicago, IL)
- …and tailored capital solutions. Job Description The Underwriting Quality Auditor ensures the integrity, consistency, and compliance of underwriting practices ... including Microsoft Excel Preferred Qualifications Background in quality assurance, claims , compliance, or knowledge of multiple insurance lines including specialty… more
- Warner Music Group (New York, NY)
- …the contractually-defined scope) of the audit concerned; + Review and analyze the audit claims submitted by the auditor in question, as well as the relevant ... including, without limitation, tracking audit notifications, reviewing and analyzing the claims contained in the audit reports we receive, making recommendations to… more
- Johns Hopkins University (Baltimore, MD)
- …plans. Represent department on assigned Institutional committees Mentor and guide internal auditor staff in the execution of their assigned projects. Demonstrate a ... Leadership of complex audits covering health plan functions such as claims processing, premium billing, encounter data, utilization management, risk adjustment,… more
- Elevance Health (Nashville, TN)
- ** Claims Auditor I, II and Senior** **Location :** This role enables associates to work virtually full-time, with the exception of required in-person training ... for employment, unless an accommodation is granted as required by law._ The ** Claims Auditor I** is responsible for pre and post payment and adjudication audits… more
- Prime Therapeutics (Richmond, VA)
- …career? Come build the future of pharmacy with us. **Job Posting Title** Pharmacy Claims Auditor - Remote **Job Description** The Pharmacy Claims ... analysis of large datasets and audit findings to detect high-risk pharmacy claims , identify billing irregularities, and uncover patters of non-compliance or systemic… more
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