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Description The Behavioral Health Clinical Advisor (Care Manager, Telephonic Behavior Health 2) will audit CPT (Current Procedural Terminology) codes to ensure correct billing under TOM (TRICARE Operations Manual) policies in accordance ..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Dover Delaware Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
... The Associate Director for ACD Audit , at the director of ... Orders, for ACD Program Integrity Audit; driving to operational excellence, repeatable ... system needs, data needs, provider..
Description The Risk Management Professional 2 a critical member within Humana's Third Party Risk Management Program (TPRM), a 2nd Line of Defense function, will be responsible for maturing our program by ..
... looking for an experienced Senior Healthcare Investigator to join its industry ... practices. Prepares complex investigative and audit reports. Begins to influence department's ... Qualifications Bachelor's degree or significant..
Job Information Humana Nurse Auditor 2/ER - WFH/REMOTE-- Anywhere in the US in Dover Delaware Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and ..
... determination processes and Medical Director audit processes. . Provide oversight and ... years of management experience within Healthcare A current and unrestricted physician ... their home. We are a..
Job Information Humana Manager, Fraud and Waste-Remote US in ... in Dover Delaware Description The Manager, Fraud and Waste conducts investigations ... fraudulent and abusive practices. The Manager, Fraud and..
Description The Vendor Quality Medical Director will manage clinical vendor quality outcomes for Humana Clinical Operations Team. Responsibilities A full time Medical Director to manage clinical vendor quality outcomes for Humana ..
Job Information Humana Inpatient Medical Coding Auditor (MSDRG/ APDRG)-Remote/Virtual in US in Dover Delaware Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate ..
Job Information Humana Inpatient Medical Coding Auditor-Remote/Virtual in US in Dover Delaware Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology ..
Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical Coding ..
... (CCM) organization is seeking a Manager, Fraud & Waste to join ... join the Provider Payment Integrity-Clinical Audit team working remote anywhere in ... As the Fraud & Waste..
... Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical ... in compiling and presenting your audit findings? If you answered YES ... production based environment of clinical..
Job Information Humana Bilingual Quality Auditor in Dover Delaware Description The Bilingual Quality Auditor/ Professional 2 ensures that products meet specific Centers for Medicaid and Medicare Services standards of quality. Review ..
... review, provider record updates, and audit preparation as defined by the ... medical records. Print and prepare audit folders. Update the web application ... Qualifications 2 plus years of..
Job Information Humana Director, Behavioral Health Strategy in Dover Delaware Description The Director, Behavioral Health (DBH) will ensure that populations served by Humana Healthy Horizons have access to quality care for ..
Job Information Humana Outpatient Medical Coding Auditor-Remote/Virtual in US in Dover Delaware Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology ..
... Compliance & Risk Management Quality Audit (QA) Risk Management Professional 2-Remote, ... Compliance & Risk Management Quality Audit (QA) Risk Management Professional 2, ... include: Collaborate with the Quality..
... is looking for an experienced Healthcare Investigator to join its industry ... billing practices. Prepares investigative and audit reports. Begins to influence department's ... areas Bachelor's degree or significant..
Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM and PCS) to patient records. The Medical ..
