- LogixHealth (Bedford, MA)
- Location: On-Site in Bedford, MA This Role: As a Claims Specialist, you will work with internal teams to provide cutting-edge solutions that will directly improve ... the healthcare industry. You'll contribute to our fast-paced, collaborative environment...and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,… more
- Commonwealth Care Alliance (Boston, MA)
- …(must have): * 5+ years in healthcare compliance, regulatory affairs, or claims audit . * Experience working with TPA partners (eg, Cognizant) and submitting ... 011250 CCA- Claims Position Summary: Reporting to the Director, ...for ensuring CCA's operational compliance with state and federal healthcare regulations, particularly MassHealth (Massachusetts Medicaid) and CMS Medicare… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …of claims data and analysis, with experience working in the MD Audit tool preferred. + Knowledge of healthcare financial management principles/practices. + ... **Overview** **Be inspired. Be rewarded. Belong. At Emory Healthcare .** At Emory Healthcare we fuel...Atlanta, GA **Description** + Reporting to the Director, Compliance Audit and Analysis, oversees audits, monitoring, and education for… more
- Guidehouse (El Segundo, CA)
- …is expected to perform all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims . Must work with other ... Billing Emphasis + Correcting and billing electronic and hardcopy claims + Submits Adjusted claims + Provides...or insurance information. + Works all rejection and payer audit reports within 48 hours of receipt taking whatever… more
- Zelis (TX)
- …Overview We are seeking a detail-oriented and technically skilled analyst to support healthcare claims repricing and data validation efforts. In this role, you ... insights. Success in this role requires deep familiarity with healthcare claims data, strong SQL proficiency, and...SQL queries (joins, CTEs, subqueries) to extract, manipulate, and audit claim data. + Evaluate pricing scenarios based on… more
- Prime Healthcare (Ontario, CA)
- …improve the quality and minimize process cost of Claims for all Prime Healthcare 's self-insured Employee Health Plans. Through in-depth audit and review of ... is a rewarding #jobs. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/196005/vp-of-health-plan-operations-and- claims /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare Management Inc… more
- LA Care Health Plan (Los Angeles, CA)
- … is responsible for various tasks within the Financial Compliance Unit, including audit of claims processed by medical groups and health plans contracted ... regulatory and contractual requirements. Communicate issues and findings that would affect the audit results. Perform claims audits for all medical groups and… more
- Elevance Health (Houston, TX)
- **External Audit Facilitator** **Location:** This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while ... a dynamic and adaptable workplace. Alternate locations may be considered. The **External Audit Facilitator** is responsible for managing the process for claims … more
- CenterLight Health System (NY)
- …effectiveness of the claims department by timely and accurate processing of claims appeals and performing claims audit , ensuring payment integrity and ... application of transaction by our TPA. + Perform in-depth claims audit to confirm that all medical...Education: Bachelor's degree required. Experience: + 1-3 years of healthcare experience, managed care setting is strongly preferred. +… more
- LogixHealth (Bedford, MA)
- …teams to provide cutting edge solutions that will directly improve the healthcare industry. You'll contribute to our fast-paced, collaborative environment and bring ... issues and appeal if necessary, using software or other resource tools + Prepare audit results and keep department manager current of all findings and audits and… more