- Conduent (Warren, MI)
- …and be part of a culture where individuality is noticed and valued every day. ** Claims Auditor ** **Position is onsite in Warren, MI** Training: Mon- Thur ( On ... audit, processing, accrual and forecasting of supplier obsolescence and cancellation claims in accordance with GM's Standard Terms and Conditions. Primary… more
- Humana (Lansing, MI)
- …Coding Quality Team is looking is an experienced and well-grounded medical coding auditor to quality review the inpatient hospital claims for proper ... this role, you will conduct quality reviews of coding processes within the Claims Cost Management organization, including offshore and vendor partners, with a focus… more
- Elevance Health (Dearborn, MI)
- **DRG CODING AUDITOR ** **Location** : _This position will work virtually._ _Alternate locations may be considered._ The **DRG CODING AUDITOR ** is responsible for ... auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines… more
- Highmark Health (Lansing, MI)
- …Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA) + 5 years with hospital or physician coding and/or ... and communication skills Preferred + Associate's Degree + 3 years with claims processing and data management + Past auditing and strong education/training background… more
- Ascension Health (Kalamazoo, MI)
- …the time of the offer._ **Responsibilities** Perform periodic and ongoing audits of claims to ensure accuracy of coding and billing, and sufficiency of supporting ... documentation. + Audit specified number of records per coder as defined in the system coding audit plan. + Prepare audit reports that are issued to key stakeholders, as appropriate. + Develop corrective action plans to address opportunities for coding, billing… more
- McLaren Health Care (Shelby Township, MI)
- …and efficiency in physician documentation, code assignment, data collection, and claims processing. 3. Performs retrospective, random, and focused audits of coding ... cases to ensure correct coding, legal compliance, and complete charge capture. 4. Evaluates the proper assignment of procedure, modifier, and diagnosis codes to professional services to validate accuracy and compliance. 5. Reports quality results, tracking and… more
- Elevance Health (Dearborn, MI)
- …and audit schedule. + Reviews, negotiates, and approves scope presented by external auditor . + For implementation audits, ensures the claims system is coded ... Audit Facilitator** is responsible for managing the process for claims and customer service audits/quality control reviews, including implementation audits,… more
- R1 RCM (Detroit, MI)
- …help review and interpret medical records to draft appeals of denied and underpaid claims . Every day you will review medical records to ensure appropriate coding of ... and interpret medical records to appeal denied and underpaid claims . + Apply clinical judgment and knowledge for DRG...a Clinical Validation Review by an insurer or third-party auditor . + Draft appeal letters that are well-written, logically… more