expertise in Medicaid program integrity policy, Medicaid enterprise systems, and claims audits to assist clients with prevention..., behavioral health, and pharmacy claims audits. Travel Expectation: Up to 50% travel to client sites nationwide...
Overview: The Healthcare Delivery Auditor supports Central Health’s mission to provide access to high-quality care.... The Auditor plans and performs audits across Central Health’s healthcare network, which includes contracted providers...
coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation... documentation techniques, medical terminology and disease processes as it relates to the DRG/APC and other clinical data quality...
Configuration Auditor contractor to join the Claims Quality Assurance team. In this role, you will be a vital safeguard, ensuring..., and pinpoint opportunities for improvement. Collaborate for Quality: Partner with internal teams, including Claims Operations...
Commonwealth, who is appointed by the Governor, Attorney General and Auditor. M.G.L. c. 12A, § 2. The OIG is organized into three... enforcement state and federal prosecutors. AOI may be investigating claims of public corruption or other wrongdoing...
This is a remote contract position. We are seeking an experienced DRG Validation Auditor with strong CDI expertise... to perform documentation and coding reviews that will support the development of our AI-driven auditing platform. The Auditor...
with a multi-speciality coding background. The Coding Quality Auditor is responsible to ensure Health Ministries Clinic...Health Ministries Clinic (HMC) is seeking a Coding Auditor (with PCP auditing experience) as a trusted expert...
and Compliance Auditor- Behavioral Health performs complex review and adjustments of medical claims to ensure accuracy in claim... claims to identify overpayments and inform resolution of root cause issues with system configuration, provider contracts...
Description : IKS Health is seeking to hire a Facility Outpatient Auditor. About IKS: Job Summary: Conducts... clinical coding audits as defined by client contracts for audit service and internal quality assessment according...
, other requirements for the position, and employer business practices. What You Will Do The Compliance Coding Auditor is responsible... and maintenance of a high-quality, effective, best practices coding, billing, and reimbursement audit compliance program to prevent...
and Responsibilities Job Summary / Purpose The Sr Coding Compliance Auditor is responsible for reviewing chart notes for proper coding... Category (HCC) Quality program was developed by CMS to promote quality care for Medical Advantage members. By focusing...
and Responsibilities Job Summary / Purpose The Sr Coding Compliance Auditor is responsible for reviewing chart notes for proper coding... Category (HCC) Quality program was developed by CMS to promote quality care for Medical Advantage members. By focusing...
Auditor is responsible for reviewing chart notes for proper coding with an emphasis on documentation, coding improvement... improvement efforts across the medical group. The Hierarchical Condition Category (HCC) Quality program was developed by CMS...
Auditor is responsible for reviewing chart notes for proper coding with an emphasis on documentation, coding improvement... improvement efforts across the medical group. The Hierarchical Condition Category (HCC) Quality program was developed by CMS...
Position Summary: The Compliance Auditor supports an effective compliance program by planning and executing risk..., and foundational healthcare regulations (e.g., Anti‑Kickback Statute, False Claims Act, EMTALA). Intermediate proficiency...
) Job Description: JOB SUMMARY The CRC Auditor, conducts coding and documentation quality reviews and generates responses for cases that have been... and / or a formal appeal letter. The Auditor will escalate trends to CRC leadership, Conifer Quality & Performance leadership...
UPMC Health Plan has an exciting opportunity for a Risk Adjustment Clinical Auditor/Analyst position in the Medicare... Auditor/Analyst is an integral part of the Risk Adjustment Department and is responsible for reviewing and auditing medical...
Job Category: Premium Audit Job Description: Job Opportunity: Senior Premium Auditor We are currently seeking... a Senior Premium Auditor with a strong and extensive background in completing Workers' Compensation and General Liability...
Overview: Presbyterian is seeking a talented Pro Fee Auditor/Educator With minimal supervision directly supports... the following responsibilities of the Coding and documentation quality assurance (CDQA) team: implementation...
Overview Presbyterian is seeking a talented Hybrid Pro Fee Auditor/Educator With minimal supervision directly... supports the following responsibilities of the Coding and documentation quality assurance (CDQA) team: implementation...