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... Required Qualifications Bachelor's degree in Healthcare or equivalent years of experience ... RN license 2 years of healthcare experience within a fraud investigations ... well as solid knowledge of..
Description The Director of Health Services for National Medicaid Clinical Operations utilizes clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Director, Health ..
Description The Nurse Auditor 2 performs clinical audit/validation processes ... support optimal reimbursement. The Nurse Auditor 2 work assignments are varied ... when they happen. The Nurse Auditor 2 validates..
... drug interactions and offering preventive healthcare services such as immunizations. Responsible ... experience by increasing focus on healthcare services (e.g. patient consultation, medication ... as requested by Store Manager,..
... Information Humana Inpatient Medical Coding Auditor-Remote/Virtual in US in Torrance California ... California Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
Description The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an ..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Torrance California Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
Description The Senior Clinical Fraud and Waste Professional performs analysis of clinical investigations of allegations of fraudulent and abusive practices. The Senior Clinical Fraud and Waste Professional work assignments involve moderately ..
Description Responsibilities The Associate Director for ACD Audit , at the director of the Director of Payment Integrity, will create and implement process improvement plans focused on the beneficiary and provider ..
... Information Humana Outpatient Medical Coding Auditor-Remote/Virtual in US in Torrance California ... California Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
Description Responsibilities The SIU and PPI Lab review team is seeking a Medical Coding Auditor with a special set of skills. This person will focus on coding and clinical review of ..
Description Humana's Claims Cost Management (CCM) organization is ... support our efforts for ensuring claims payment accuracy, so that our ... that our members receive quality healthcare at an affordable..
Description The Payment Integrity Professional 2 uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our ..
JOB SUMMARY Lead all Medicare Advantage Risk Adjustment coding initiatives including prospective chart review and prep, retrospective chart review and audit, and provider education. Manager will coordinate with operations leaders and ..
Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding Auditor work assignments are varied and ... for an experienced medical coding auditor to..
... is looking for an experienced Healthcare Investigator to join its industry ... areas Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 1 year of..
Physician Billing Specialist - FT/Days (Hybrid 8hrs)','MEM007254','!*!Cardiology/Hybrid Review daily assigned tasks through the applications and as assigned . Contact insurance companies, other third party payers regarding claims status and payments via ..
Job Information Humana Medical Coding Auditor - Outpatient & Surgical Specialty ... California Description The Medical Coding Auditor reviews medical claims submitted against medical records provided, ... CPT, HCPCS). The..
... looking for an experienced Senior Healthcare Investigator to join its industry ... Qualifications Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 3 years of..
Job Information Humana Manager, Fraud and Waste-Remote US in Torrance California Description The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste ..
... Information Humana Inpatient Medical Coding Auditor (MSDRG/ APDRG)-Remote/Virtual in US in ... California Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
Description Responsibilities The Compliance Professional 2 has responsibilities for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism Care Demonstration ..
