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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..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Boston Massachusetts Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
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 will work on the ... lab audit concepts. The Nurse Auditor 2 will perform clinical audit ... waste, and abuse. The Nurse Auditor 2 work..
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..
... Information Humana Outpatient Medical Coding Auditor-Remote/Virtual in US in Boston Massachusetts ... Massachusetts Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
Job Information Humana Medical Coding Auditor - Outpatient & Surgical Specialty ... Massachusetts Description The Medical Coding Auditor reviews medical claims submitted against medical records provided, ... CPT, HCPCS). The..
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..
Job Information Humana Manager, Fraud and Waste-Remote US in Boston Massachusetts Description The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste ..
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 ..
... Information Humana Inpatient Medical Coding Auditor (MSDRG/ APDRG)-Remote/Virtual in US in ... Massachusetts Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
... 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..
POSITION SUMMARY: The Clinical Reimbursement Coordinator (RN) manages the overall process and tracking of all Medicare/Medicaid case-mix documents in order to assure appropriate reimbursement for services provided within the Center. Conducts ..
... Information Humana Inpatient Medical Coding Auditor-Remote/Virtual in US in Boston Massachusetts ... Massachusetts 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 ..
: The Business Office Manager “BOM” must be familiar with companypolicies and procedures related to all areas of Revenue Cycle Management, which includes census,ancillaries, billing, adjustments, deposits, collections, Medicaid Pending and ..
... 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..
... 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 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 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..
