- UC Health (Cincinnati, OH)
- …an inclusive, equitable and diverse place of employment. The Charge Master Auditor is responsible for executing charge related audits. They assist in evaluating ... compliance related services that resolve charging discrepancies and provide charging related outreach education to clinical departments on charging processes and procedures. Instrumental in working Infusion related edits and providing education to our Infusion… more
- Prime Therapeutics (Columbus, OH)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Pharmacy Claims Auditor - Remote **Job Description** The Pharmacy Claims ... Auditor is responsible for the selection and auditing of claims , educating Prime's network pharmacies and driving contract compliance, and supporting downstream… more
- Sedgwick (Cleveland, OH)
- …provided to insurance carriers, corporate legal departments and government entities. The auditor will apply client specified billing guidelines and/or Generally ... Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Attorney Auditor ** **This is a fully remote position, and candidates residing in any… more
- Elevance Health (Mason, OH)
- …coding or quality assurance environment preferred. + Broad knowledge of medical claims billing /payment systems provider billing guidelines, payer ... **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ __ _This...auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all… more
- Elevance Health (Columbus, OH)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... **Diagnosis Related Group Clinical Validation Auditor -RN** **Virtual:** This role enables associates to work...Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes… more
- Elevance Health (Columbus, OH)
- …associated with fraud and abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines and identifies ... **Clinical Provider Auditor II** **Supports the Payment Integrity line of...prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses… more
- Highmark Health (Columbus, OH)
- …activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code ... which supports compliant coding. Interacts with external consultants regarding billing , coding and/or documentation and evaluates their recommendations and/or… more
- Humana (Columbus, OH)
- …3 or more years of healthcare experience in revenue cycle management (related to billing , coding, collections for Medicare and Medicaid claims ) + Experience with ... federal and/or state requirements related to Provider Clinic operations, billing , investigations, and processes. Coordinates site visits for regulators, coordinates… more
- Molina Healthcare (OH)
- …abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims . ( _Use for claims specific positions only_ ) * Prepares, tracks ... including, but not limited to; vendor, focal, audit the auditor . Confirm that documentation is clear and concise to...to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of… more
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