- Robert Half Accountemps (Boston, MA)
- Description Job Title: Medical Claims Auditor - RN Auditor Location: Massachusetts - 90% Remote Job Type: 1 Year Contract - Potential for Perm Hire ... 1, 2025 Job Description We are seeking a qualified Auditor with healthcare experience to support Program Integrity activities...perform onsite audits (1-4 times per month) + Evaluate claims and provider documentation for compliance and accuracy +… more
- CHS (Clearwater, FL)
- …(Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical insurance claims and customer service calls to ... Responsibilities:** + In accordance with company guidelines, performs random medical audits, target audits, re-audits, etc and audits for...and lifting up to thirty (30) pounds. ** ** ** Claims and Call Auditor (Call Center QC)… more
- LA Care Health Plan (Los Angeles, CA)
- Specialty Health Plans Auditor III Claims Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: ... safety net required to achieve that purpose. Job Summary The Specialty Health Plans Auditor III Claims is responsible for all aspects of planning, execution,… more
- UCLA Health (Los Angeles, CA)
- …with: + High school diploma, GED or equivalent + Four or more years of medical claims payment experience in an HMO environment + Experience with CPT-4, ICD-9CM, ... do all this and more at UCLA Health. The Claims Quality Auditor will be responsible for...medical terminology + Experience in benefit determination and claims adjudication + Ability to accurately key 6,000-8,000 keystrokes… more
- Cognizant (Olympia, WA)
- ** Claims Auditor ** (remote) This is a remote position open to any qualified applicant that lives in the United States. **Summary:** Our Cognizant leadership ... to perform the following duties and work as part of our established claims adjudication team. We are seeking highly motivated healthcare professionals with auditing… more
- Conduent (Los Angeles, CA)
- …be part of a culture where individuality is noticed and valued every day. **Pharmacy Claims Auditor CPhT** **Do you have a CPhT certification?** **Would you like ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a...sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service… more
- WTW (Chicago, IL)
- …PPO, Indemnity and Managed Care + Must demonstrate a high level of claims administration knowledge, including experience with medical , dental, mental health and ... **Description** As a Lead Auditor you will apply your audit, project management...will review discrepancy issues identified by field auditors, re-adjudicate claims , resolve open issues, and draft the final report.… more
- UCLA Health (Los Angeles, CA)
- …* Bachelor's degree and/or equivalent experience * Five or more years of medical claims payment experience in Medicare Advantage or combination of equivalent ... random and focus audits of all claim processing activities to identify inaccurate claims adjudication. This will involve reviewing UB04 and CMS 1500 healthcare … more
- Insight Global (St. Petersburg, FL)
- Job Description In accordance with company guidelines, performs random medical audits, target audits, re-audits, etc and audits for claims which are in excess of ... and reporting requirements; Federal and state regulations; and timeliness of claims processing. Utilize Excel, prepares tracking and trending written audit reports… more
- Humana (Boise, ID)
- …you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider ... community and help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from...payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments.… more