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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 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 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 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 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..
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..
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..
... to efficiently submit medical insurance claims for all payers including Medicare ... billing workload.n Monitor and resolve claims holding on discharged not final ... standards of compliance.n Assure all..
Job Information Humana Medical Coding Auditor - Outpatient & Surgical Specialty ... Kentucky Description The Medical Coding Auditor reviews medical claims submitted against medical records provided, ... CPT, HCPCS). The..
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..
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 ..
Location : US Type : Full-Time Salary : $19.00 - $23.00 / Hourly / DOE This is a full-time position that will be based from your home office, reporting to the ..
Job Information Humana Medical Coding Auditor (Evaluation & Management experience required) ... Kentucky Description The Medical Coding Auditor reviews medical claims submitted against medical records provided, ... are met. The..
... 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-Remote/Virtual in US in Louisville Kentucky ... Kentucky 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 Louisville Kentucky ... Kentucky Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
Job Information Humana Manager, Fraud and Waste-Remote US in Louisville Kentucky Description The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste ..
... Oversight to the WPS Duplicate Claims System load completion to meet ... to include oversight of Duplicate Claims System. Vendor management of WPS ... also coordinate related efforts with..
Job Information Humana Senior Consumer Service Operations Analyst-Remote KY, IN or WI in Louisville Kentucky Description The Senior Consumer Service Operations Professional is responsible for the daily activities across multiple service ..
Description The Director HEDIS Production and Quality Analytics takes the lead in driving success for key quality measures development and analytic reporting functions that support Humana Military clinical quality strategies, including ..
... 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..
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, ..
... Information Humana Inpatient Medical Coding Auditor (MSDRG/ APDRG)-Remote/Virtual in US in ... Kentucky Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
