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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 ..
Description The Nurse Auditor 2 performs clinical audit/validation processes ... support optimal reimbursement. The Nurse Auditor 2 work assignments are varied ... is looking for a Nurse Auditor 2 Professional..
Job Information Humana Licensed Behavioral Health Professional - Quality Audit in Pittsburgh Pennsylvania Description Humana Healthy Horizons in Ohio is seeking a Licensed Behavioral Health Quality Audit Professional. This position ensures ..
... 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..
... 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 The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM and PCS) to patient records. The Medical ..
Job Information Humana Medicare Enrollment Representative 2 - Remote in Pittsburgh Pennsylvania Description The Enrollment Representative 2 processes applications from members, enrolls them on company platforms, and transmits enrollment to Center ..
Outpatient Risk Coder – National This position reports to the Manager of Risk Adjustment Coding. As a member of the Risk Adjustment team, the Outpatient Risk Coder works remotely in collaboration ..
Description The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Compliance Nurse ..
Job Information Humana Senior Compliance Registered Nurse in Pittsburgh Pennsylvania Description Humana Healthy Horizons in Ohio is seeking a Senior Compliance Nurse. This position ensures mandatory reporting for Case Management and ..
Description The Fraud Investigation Technician 2 conducts investigations of allegations of fraudulent and abusive practices. The Fraud Investigation Technician 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. ..
Job Information Humana Clinical Auditor Registered Nurse Care Management or Utilization Management in Pittsburgh Pennsylvania Description Humana Healthy Horizons in Ohio is seeking a Utilization and Case Management Clinical Auditors. This ..
Description The Medical Coding Auditor reviews medical records to verify coding (ICD-10 CM/PCS). The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate ..
... 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..
