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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 The Senior Claims Process & Policy Professional processes ... modifications to existing policies, and claims forms. The Senior Claims Process & Policy Professional work ... variable factors. Responsibilities The..
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..
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..
Job Information Humana Process Improvement Lead South Carolina Medicaid (Utilization and Case Management) in Tampa Florida Description The Process Improvement Lead analyzes, and measures the effectiveness of existing business processes and ..
... 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..
... Information Humana Inpatient Medical Coding Auditor (MSDRG/ APDRG)-Remote/Virtual in US in ... Florida Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
... Information Humana Inpatient Medical Coding Auditor-Remote/Virtual in US in Tampa Florida ... Florida Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
Description The Risk Management Lead - Home Health works as a partner with Home Solutions teams to evaluate and analyze business processes, potential issues, and strategic opportunities to minimize risk, ensure ..
... 5 or more years of healthcare revenue cycle management experience may ... for Medicare and Medicaid related claims) Experience with Auditing and monitoring ... with Auditing and monitoring of..
... Information Humana Outpatient Medical Coding Auditor-Remote/Virtual in US in Tampa Florida ... Florida Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
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..
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..
Job Information Humana Manager, Fraud and Waste-Remote US in Tampa Florida Description The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste ..
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 ..
Job Information Humana Medical Coding Auditor - Outpatient & Surgical Specialty ... Florida Description The Medical Coding Auditor reviews medical claims submitted against medical records provided, ... CPT, HCPCS). The..
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 ..
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 ..
Description The Plan Build Representative 3 selects, implements, and loads the system applications that administer provider's contracts. The Plan Build Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative ..
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..
... identify, assess, monitor and document claims and encounter coding information as ... Assess adequacy of documentation of claims and query outpatient provider claims to obtain additional medical record .....
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 ..
