• Claim Edit and Vendor…

    Geisinger (Danville, PA)
    …recommends changes for the yearly opportunity analysis. + Reviews and responds to claim edit appeals and rational requests. + Coordinates, supports, and resolves ... vendor needs both prospectively and retrospectively. + Problem solves system/ claim edit issues that may come up. + Tests and verifies new claim edits as… more
    Geisinger (12/17/25)
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  • Payment Integrity Coding Professional

    Humana (Harrisburg, PA)
    …us put health first** The Payment Integrity Coding Professional within Code Edit Vendor Management (CEVM) contributes to overall cost reduction by utilizing ... code editing guidelines and data anomalies to ensure correct claim payment. The Payment Integrity Professional work...+ Experience using the following systems: CAS and Code Edit vendor tools + Experience in a… more
    Humana (12/18/25)
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  • MCO Director Payment Integrity

    AmeriHealth Caritas (Newtown Square, PA)
    …**Director of Payment Integrity Solutions** is responsible for overseeing Payment Integrity edit and program strategy and performance across all ACFC lines ... CMS guidance and experience with Medicaid + Working knowledge of payment integrity regulations and requirements + Experience with claims adjudication platforms… more
    AmeriHealth Caritas (11/21/25)
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  • Senior Payment Accuracy Analyst

    UPMC (Pittsburgh, PA)
    …Health Information Technician (RHIA/RHIT) preferred, but not required + Ability to interpret claim edit rules and references + Solid understanding of claims ... your opportunity to make a real impact on payment integrity and compliance while collaborating with talented teams across...claim processes + Ability to perform audits of claims processes and apply root-cause + Significant experience with… more
    UPMC (12/18/25)
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