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Description The Senior Claims Research & Resolution Professional manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claims issues/complaints within contractual ..
Description Our search is focused on identifying a certified coder who will primarily be responsible for conducting prospective and concurrent reviews to identify documentation improvement opportunities according to CMS and ICD-10 ..
Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The ..
... looking for an experienced Senior Healthcare Investigator to join its industry ... provider records ensuring appropriateness of billing practices. Prepares complex investigative and ... Qualifications Bachelor's degree or significant..
... is looking for an experienced Healthcare Investigator to join its industry ... provider records ensuring appropriateness of billing practices. Prepares investigative and audit ... areas Bachelor's degree or significant..
... for diagnosis code selection Educate healthcare provider, coder and/or office staff ... long-term, self-sustaining solution for the healthcare provider's practice Assist healthcare providers to document accurately and ... job..
Description The Nurse Auditor 2 will work on the clinical research and development team with coders, clinicians and genetic counselors to develop, implement and maintain clinical lab audit concepts. The Nurse ..
Description Humana Healthy Horizons in Florida is seeking a STARS Improvement Professional 2 who will develop, implement, and manage oversight of the company's Medicaid Stars Program. They will direct all quality ..
Job Information Humana Associate Director, Site Reliability Engineering in Colorado Springs Colorado Description The Associate Director, Site Reliability Engineering maintains, integrates and implements software applications within the organization. The Associate Director, ..
Description Manages a team of coding educators and reports to Risk Adjustment Director. Responsible for implementing operational and clinical best practices in the risk adjustment methodology, understanding clinical suspects and appropriate ..
Job Information Humana Sr Medicare Risk Adjustment Coding & Documentation Improvement Professional - WAH AZ or CO in Colorado Springs Colorado Description Sr Medicare Risk Adjustment Coding & Documentation Improvement Professional ..
Description Be a part of an interactive team with broad exposure and scope within Humana. Humana is seeking a positive and proactive individual to contribute to a high performing team that ..
Job Information Humana Nurse Auditor 2/ER - WFH/REMOTE-- Anywhere in the US in Colorado Springs Colorado Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation ..
Description Our search is focused on identifying an individual contributor who will take ownership of Medicare risk adjustment programs that fit best with our providers by implementing operational and clinical best ..
Job Information Humana Genetic Counselor (Board Certified)-Remote/Virtual in US in Colorado Springs Colorado Description Humana is seeking a Board Certified Genetic Counselor to join our Special Investigations Unit - Clinical Review ..
Job Information Humana Call Center Pharmacy Claims Technician, Remote in Colorado Springs Colorado Description The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims ..
Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. Responsibilities ..
Description Assist local pharmacies with claims adjudication to support medication access for HC & LTC hospice patients; reconcile historic billing issues. Responsibilities There are 4 shifts available for this role. All ..
... 5 or more years of healthcare revenue cycle management experience may ... experience may suffice (to include, billing, coding, collections for Medicare and ... with Auditing and monitoring of..
Job Information Humana Manager, Fraud and Waste-Remote US in Colorado Springs Colorado Description The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and ..
As a Medical Assistant, you’ll provide an exceptional experience for our patients and help them accomplish an important part of their care journey by providing venipuncture as well as other clinical ..
