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... contract is responsible for processing claims for more than 6 million ... than 6 million members, the claims processing and financial management functions ... to an external vendor. The..
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 ..
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 ..
... when they happen. The Nurse Auditor 2 validates and interprets medical ... of par and non-par provider claims to determine payment accuracy. Makes ... process improvements. Reviews and audits..
Description Responsibilities The Claims Quality Audit Professional 1 works with the Resolution Quality Audit leadership team to support efficiency and day to day operations. Requires in-depth knowledge of Microsoft products Excel, ..
Job Information Humana Manager, Fraud and Waste-Remote US in Indianapolis Indiana Description The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste ..
Description The Medical Coding Auditor extracts clinical information from a ... coding guidelines. The Medical Coding Auditor work assignments are varied and ... guidelines/procedures. As a Medical Coding Auditor for..
... 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..
... 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..
Description The Nurse Auditor 2 will work on the ... lab audit concepts. The Nurse Auditor 2 will perform clinical audit ... waste, and abuse. The Nurse Auditor 2 work..
... Information Humana Inpatient Medical Coding Auditor-Remote/Virtual in US in Indianapolis Indiana ... Indiana Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
... Information Humana Inpatient Medical Coding Auditor (MSDRG/ APDRG)-Remote/Virtual in US in ... Indiana Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
... Information Humana Outpatient Medical Coding Auditor-Remote/Virtual in US in Indianapolis Indiana ... Indiana Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
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 ..
Job Information Humana Medical Coding Auditor - Outpatient & Surgical Specialty ... Indiana Description The Medical Coding Auditor reviews medical claims submitted against medical records provided, ... CPT, HCPCS). The..
Description Responsibilities The Utilization Management Nurse 2 will be responsible for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism ..
Job Information Humana Senior Consumer Service Operations Analyst-Remote KY, IN or WI in Indianapolis Indiana Description The Senior Consumer Service Operations Professional is responsible for the daily activities across multiple service ..
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 ..
... (ACD). The technician assists with claims review, provider record updates, and ... 30% Assist with submission of claims corrections and recoupments, while monitoring ... Qualifications 2 plus years of..
Description The Medical Coding Auditor reviews medical claims submitted against medical records provided, ... are met. The Medical Coding Auditor work assignments are varied and ... action. Responsibilities The Medical..
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 ..
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 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..
