Claims Auditor I: Ensure Accurate Payments & Compliance
Solis Health Plans
Solis Health Plans is seeking a Claims Auditor I in Doral, FL to perform pre- and post-payment audits of Medicare claims, ensuring payment accuracy and compliance with CMS guidelines within a managed care setting. The ideal candidate has a High School Diploma, 5 years of claims processing experience, and at least 1 year in quality or claims auditing, with strong attention to detail and analytical skills. #J-18808-Ljbffr Solis Health Plans
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Claims Auditor I: Ensure Accurate Payments & Compliance in Florida, NY vacancy
- Solis Health Plans, Inc. in Doral, FL is seeking a Claims Auditor I to perform pre- and post-payment audits of health plan claims, ensuring payment accuracy and CMS guideline compliance. You will review coding, pricing, and authorization requirements to identify discrepancies...Claims
- ...Services Administrators, Inc. seeks a claims analyst to process insurance claims... ..., and travel suppliers, while ensuring regulatory compliance and accurate documentation. Responsibilities include... ...with adjusters, and timely payments. A high school diploma or GED is required...Claims
- Join Our Team as an Insurance Claims Examiner - Make an Impact in Healthcare Payment Accuracy! Are you passionate about ensuring fair and accurate healthcare claims processing? We're seeking... ...for detail, and are committed to compliance, this is your chance to contribute...ClaimsWork at office
- Billing and Coding Auditor Banyan Treatment Centers is seeking a detail-oriented... ...to support the accuracy and compliance of our billing practices across our... ...health services. This critical role ensures the integrity of our claims processes and supports continuous quality...ClaimsFull timeWork experience placementWork at officeRemote workFlexible hours
- ...fraud, waste, abuse, and payment integrity risks. The FWA... ..., and supporting claims integrity and payment accuracy... ...Management, Provider Relations, Compliance, Legal, Risk, IT, and... ...integrity concerns. Ensure investigations are completed accurately, timely, and in...ClaimsFull time
$23.73 - $35.6 per hour
...alternative application process. Claims Auditor I Doral, FL, US Salary Range: $2... ...comprehensive pre- and post-payment audits of claims processed by New... ...underpayment disputes. This role ensures payment accuracy, procedural compliance, and adherence to CMS Medicare guidelines...ClaimsHourly pay- ...seeking a diligent administrator to manage Eldercare claims processing, enrollment, credentialing, and... ...coordinate with providers, vendors, and MSMC departments to ensure timely payments, accurate claims, and compliance with CMS rules. The role supports the Eldercare...Claims
- ...seeking an experienced Senior Medical Coding Auditor (CPC) to join our growing multi-... ...reviewing clinical documentation before claims are submitted to ensure accurate coding, appropriate E/M level selection, documentation compliance, and optimal reimbursement while maintaining...ClaimsHourly payPart timeWork at officeRemote workWork from homeMonday to FridayFlexible hours
$31.2 - $40.56 per hour
...serve as an expert in Outpatient Prospective Payment System or Inpatient Prospective Payment... ...medical record documentation needed for accurate coding. Prepare reports, and performs... ...and efficiency in outpatient or inpatient claims processing and data collection to optimize...ClaimsRemote jobLocal area- ...guide analysts, and optimize fraud detection strategies across Claims, Compliance, and IT teams. Qualifications include a healthcare/admin... ...emphasizes leadership, data-driven insights, and industry-standard payment integrity practices. #J-18808-Ljbffr BEST DOCTORS INSURANCE...Claims
- Vaco is hiring for Healthcare Payment Posting Specialist for a role in Miramar, FL... ...position promotes revenue integrity by ensuring timely and accurate posting of accounts and maintains... ...Care, Third Party payors, PIP, filing claims by electronic method, etc. Knowledge...Claims
- ...validate large data sets to ensure accuracy before... ...prior quarter adjustments accurately and timely... ...challenge inaccurate claims Maintain detailed documentation... ...timely disbursement of payments Data Preparation &... ...update SOPs to ensure compliance and process accuracy...ClaimsContract work
- ...Florida JOB SUMMARY The ACH Payment Specialist plays a critical role in ensuring the efficient and... ...to disputes and Reg E claims and timeframes. Review... ...Reserve. Monitor and review compliance for regulation E as it... ...duties are completed accurately and timely. Provide...Claims
- ...clinical conditions that accurately reflect the severity... ...Concurrent outpatient claim diagnosis coding... ...clarify documentation and ensure accurate coding and reporting... ...to ensure compliance and accuracy in coding... ...coding conventions and payment rules as they apply to...Claims
- ...Overview Vice President, Auditor, Operations and Payments At BNY, our culture allows us to run our company... ...Oversee end-to-end audit delivery, ensuring timely completion and adherence to internal... ...effectiveness. Regulatory & Policy Compliance: Ensure audits address key...WorldwideFlexible hours
- ...in insurance regulatory and compliance requirements to guide strategy... ...propositions for underwriting, claims, risk, and customer... ...contract closure while maintaining accurate pipeline forecasting and CRM... ...teams to develop campaigns, ensure smooth project handovers, and...ClaimsContract work
- ...Billing Specialist I to manage daily download/edit of managed care claims, ensuring accurate, timely transmission to payers. You will coordinate with other departments to resolve data issues and maintain compliance with HIPAA, coding and payer requirements. Minimum 3-5 years...Claims
- ...billing and coding to claims processing and collections... ...be responsible for ensuring the efficiency,... ...initiatives, and ensuring compliance with industry regulations... ..., claims processing, payment posting, denial management... .... Ensure timely and accurate submission of claims...ClaimsLocal areaRemote work
- ...and resolution of third‑party claims reimbursements, ensuring timely billing, collection, and payment of professional and... ...outstanding accounts, and maintain compliance with payer contracts and regulatory... ...claims to ensure accurate and timely reimbursement. Investigates...ClaimsWork experience placementWork at office
$63.59k - $114.45k
...handle meaningful, real-world claims where your judgment directly... ...negotiate equitable settlement in compliance with all state regulatory... ...regulatory coordination to ensure appropriate documentation and... ...outside of authority limits and accurately manages claims outcomes....ClaimsWork at officeLocal areaAfternoon shift- ...improve methods of ensuring efficient claims processing, prompt collections... ...development in payment posting, refund,... ...internal and external auditors. Responsible for... ...working knowledge with an accurate and timely system... .... Keeps abreast of compliance regulations, standards...ClaimsWork experience placementWork at officeLocal area
$107.7k - $199.3k
...guidance and set policies to ensure all programs adhere to... ...retrospective audits to ensure accurate and timely payments of coding and pricing... ...changes while maintaining compliance with all state and federal... ...experience. Experience in claims operations preferred. Compliance...ClaimsFull timePart timeWork at officeRemote workFlexible hours- Redion in Pembroke Pines, FL is hiring for a Claims Processing and Coordination role. You will adjudicate insurance claims, communicate... ...with insureds, travel providers, and medical facilities, and ensure compliance with state regulations. This hybrid position reports to the...ClaimsWeekend work
$200k - $230k
...Vice President of Payment Posting - Exact Billing Solutions (EBS)... ...building scalable processes, and ensuring the seamless delivery of... ...ensuring that all outstanding claims are processed, followed up on... ...process to ensure timely and accurate posting for all clients. Review...ClaimsFull timeWork at officeRemote workFlexible hours$72k - $141k
...something important, ensuring the abilities of all employees... ...best-in-class claim service. We are seeking... ...litigation and authorizing payments within scope of... ...are followed, work is accurate and timely, all files... ...expertise and ensures compliance with state/local regulatory...ClaimsWork experience placementWork at officeLocal areaFlexible hoursShift work- ...This role analyzes healthcare claims, encounter, and membership... ...Experience supporting value-based payment programs, provider... ...provider relations teams to ensure accurate interpretation and communication... ...equity, and inclusion. In compliance with Florida law, candidates...ClaimsRemote work
- ...identified providers as warranted Examines claims for compliance with relevant billing and processing... ...claims and medical records prior to payment Research new healthcare related... ...analytical skills and compliance knowledge to ensure adherence to billing guidelines and...Claims
- ...monitor oxygen prescriptions, review documents for Medicare compliance, and ensure accurate and timely billing across Brightree systems.... ...include verifying insurance eligibility for DME, processing claims, addressing denials, and collaborating with care teams to...Claims
- CTS Engines is seeking a Records Auditor to conduct thorough reviews of maintenance documentation, ensure compliance with customer requirements, and maintain accurate engine records. The role involves data entry, coordination with Shipping and Maintenance, and safeguarding...
- ...Insurance billing process including claims submission, and... ...verifications. This position ensures compliance with all Medicare guidelines... ...processes, submits clean and accurate insurance claims in a timely... ...and resolve discrepancies in payments and accounts by working the...ClaimsWork at office
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Claims Auditor I: Ensure Accurate Payments & Compliance. Be the first to apply!

