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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 Pittsburgh Pennsylvania Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
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 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..
... Information Humana Inpatient Medical Coding Auditor-Remote/Virtual in US in Pittsburgh Pennsylvania ... Pennsylvania 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 Pittsburgh Pennsylvania ... Pennsylvania Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
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 ..
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 ..
... reducing waste and overuse of healthcare services, while encouraging high value ... Trend (CAT) team needs your healthcare, analytic, and research acumen to ... have the opportunity to support..
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 ..
Job Information Humana Medical Coding Auditor - Outpatient & Surgical Specialty ... Pennsylvania 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..
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 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 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..
... (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 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 ..
... 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..
Job Information Humana Manager, Fraud and Waste-Remote US in Pittsburgh Pennsylvania 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 ... Pennsylvania Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
... 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..
