Remote CPhT Auditor: Pharmacy Claims & Compliance
Independence Blue Cross (Independence)
- Remote job
Independence Blue Cross (Independence) is seeking a fully remote Certified Pharmacy Technician Auditor to conduct audits on pharmacy claims, ensuring accurate provider payments and identifying potential fraud, waste, or abuse. The role requires an extensive understanding of audit practices, alongside the ability to analyze billing patterns. The successful candidate will maintain comprehensive documentation and prepare statistical reports based on the audits performed. A Certified Pharmacy Technician qualification and relevant experience are essential for this position. #J-18808-Ljbffr Independence Blue Cross (Independence)
- A leading healthcare solutions provider is seeking a Pharmacy Claims Auditor CPhT to conduct pharmacy audits and ensure claims accuracy. Responsibilities... ...skills. This role offers a hybrid work model, combining remote work and field audits. #J-18808-Ljbffr ConduentRemote workClaims
- Conduent Business Services is looking for a Pharmacy Claims Auditor CPhT in Chicago, IL. In this hybrid role, you will examine pharmacy records and... ...within a few months. The position offers a mix of remote and on-site work, extensive benefits, and opportunities for...Remote workClaims
- A leading service provider in Miami, FL is seeking a Pharmacy Claims Auditor CPhT to ensure accuracy in pharmacy claims. This role involves examining... .... The position offers a hybrid work model, allowing 25% remote work and includes comprehensive benefits from the first...Remote workClaimsWork at office
$57k
...Job Description Pharmacy Claims Auditor CPhT Do you have a CPhT certification? Would you like to audit pharmacy claims for accuracy? About the Role Conduent Payment Integrity Solutions performs in depth pharmacy audits on behalf of our healthcare payer...Remote workClaimsWork at officeLocal areaWork from homeFlexible hoursNight shift- A compliance and administration firm is seeking an Entry Level Account Coordinator (Pharmacy Auditor) to participate in claims audit processes remotely. Responsibilities include conducting audits to ensure proper healthcare claim practices and collaborating with the Client...Remote jobClaims
- ...Auditor, Payment Integrity Bring your drive for excellence, teamwork... ...Integrity role conducts pharmacy claim audits for Independence Blue... ...Certified Pharmacy Technician (CPhT) required. • Minimum of four... ...preferred but not required. Fully Remote: This role is designated by...Remote workClaimsWork at office
- ...leading healthcare auditing firm based in San Antonio, Texas is looking for a Pharmacy Claims Auditor CPhT. This role involves examining pharmacy records, performing audits and ensuring compliance with regulations. Candidates should possess a CPhT certification, retail...Claims
- ...personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day. Role Pharmacy Claims Auditor CPhT About the Role Conduent Payment Integrity Solutions performs in depth pharmacy audits on behalf of our healthcare payer...ClaimsWork at officeLocal areaWork from homeFlexible hoursNight shift
$57k
...to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day. Pharmacy Claims Auditor CPhT Do you have a CPhT certification? Would you like to audit pharmacy claims for accuracy? About the Role Conduent Payment...ClaimsWork at officeLocal areaWork from homeFlexible hoursNight shift- Job Summary The Pharmacy QA Specialist plays a critical... ...quality Ensure compliance with applicable state,... ...Technician Certification (CPhT or equivalent) required... ...stipend are provided for remote workspace. ABOUT DANE... ...over 200,000 insurance claims annually for leading national...Remote jobClaimsTemporary workWork at officeWork from home
- ...Fraud, Waste, and Abuse (FWA) Auditor serves a crucial role in... ...various provider types to ensure compliance with federal and state regulations... ..., including data mining, claims analysis, and medical record... ...other aspects of the job are remote. Responsibilities Responsibilities...Remote workClaimsWork at office
- ...seeking a Registered Nurse (RN) to review and evaluate medical necessity, appropriateness, quality, and compliance of services rendered by providers. This role involves claims analysis, provider audits, fraud detection, and regulatory enforcement to ensure compliance with...Remote workClaimsWork at office
- Independence Blue Cross is seeking an Auditor, Payment Integrity to conduct pharmacy claim audits ensuring accurate provider payments while detecting fraud and improving audit processes. This fully remote role requires a Certified Pharmacy Technician with at least four...Remote jobClaimsWork at office
- MedPOINT Management is seeking a Hospital Claims Auditor responsible for ensuring the quality of claims processes and compliance with health plan and hospital regulations. The... ...in medical coding and contracting. This is a remote position. #J-18808-Ljbffr MedPOINT...Remote jobClaims
- ...based in Chicago is seeking a Quality Assurance Auditor to conduct audits on medical, dental, and vision claims. The role requires a Bachelor's degree or equivalent... ...audit trends. This position offers a fully remote work environment with a competitive benefits package...Remote jobClaimsWork experience placement
- ...Coding Auditor Location: Miramar, Florida At Memorial, we are dedicated to improving... ...coding managers to analyze and resolve claim denials that are rejected by edits from... ...format compliant queries and assesses for compliance with AHIMA query standards. Reports...Remote workClaimsWork experience placementInternshipWork at officeShift work
$50k - $55k
...Medical Claims Auditor (Remote - Texas) Great companies need great teams to propel their operations. Join the group that solves business... ...reviewing and analyzing medical claims to ensure accuracy, compliance, and adherence to company and regulatory standards. This role...Remote workClaimsFull timeMonday to FridayFlexible hours- A leading claims administration firm is seeking an Attorney Auditor to review legal and non-legal invoices for accuracy. The position is fully remote, inviting candidates from across the United States... ...independently, ensuring compliance with client billing guidelines...Remote jobClaims
- A leading risk and claims administration partner is seeking an experienced Attorney Auditor. This fully remote position allows candidates from all 50 United States to apply.... ...review legal and non-legal invoices, ensuring compliance with client billing guidelines. A Judis...Remote jobClaims
- A leading risk and claims administration partner is seeking a remote Attorney Auditor in Cleveland, Ohio. This position requires a Juris Doctorate and five years of... ...include reviewing legal invoices, ensuring compliance with billing guidelines, and communicating effectively...Remote jobClaims
- ...oriented Registered Nurse Clinical Auditor to support medical record reviews and billing compliance audits for Indiana Health Coverage Programs. This remote role requires evaluating provider compliance... ...one year of experience in Medicaid claims review. Strong analytical and...Remote jobClaims
- ...Job Description The Auditor/Educator Inpatient Coding performs internal Inpatient... ...encounters to validate coding assignments is in compliance with the official coding guidelines as... ...of reimbursement methodologies and claims processing. Ability to develop educational...Remote workClaimsFull timeWork at office
$58k - $114.9k
...Remote MSDRG Auditor Category: Analytics and Emerging Digital Technologies Main location: United... ...is a member of the CGI Healthcare Compliance, DRG Validation Team, with responsibility... ...and underpayments) on paid claims on behalf of the client from various providers...Remote workClaimsFull timeContract workWork at officeLocal area$82.23k - $155.81k
...Diagnosis Related Group Clinical Validation Auditor-RN to conduct audits on inpatient... ..., ensuring documentation accuracy and compliance. This remote role requires a current Registered... ...Nurse license and extensive experience in claims auditing. Responsibilities include...Remote jobClaims$20.78 - $36.53 per hour
...Location: Remote Position Pay Range: $20.78 - $36.53 Position... ...Provide coding support for Claims Resolution Specialists. Meet... ...or concerns to Manager/Compliance Officer. Maintain and ensure... ...manner as assigned to the Auditor Queue. Audit Request (Compliance...Remote workClaims$70k - $75k
A leading risk and claims administration partner is seeking an Attorney Auditor to review legal invoices, ensuring compliance with client billing guidelines. This fully remote position requires a Juris Doctorate and five years of insurance defense or complex litigation...Remote jobClaims- A leading risk and claims administration partner is looking for an Attorney Auditor to review legal invoices and ensure compliance with client billing guidelines. This fully remote position requires a Juris Doctorate and five years of experience in insurance defense or...Remote jobClaims
- Uloop Inc. is seeking a Registered Nurse (RN) to evaluate medical necessity and compliance of services rendered. The role includes claims analysis, provider audits, and fraud detection to adhere to state and federal regulations. The ideal candidate should possess a valid...Remote jobClaimsWork at office
$59.3k - $80.9k
...caring community The Medical Coding Auditor reviews medical claims submitted against medical records... ...reviews Conduct peer reviews to ensure compliance with coding guidelines and provide... ...to make an impact WORK STYLE: Remote, work at home. While this is a...Remote workClaimsBi-weekly payFull timeContract workTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday$60.13k - $80.82k
...Type: Full Time - Permanent Remote Employment: Flexible/Hybrid... ...Division: Customer Compliance Division Opening Date: 06... ...Compliance team as a Financial Auditor (ES Benefits Specialist 3). This... ...and timely, correct benefit claims. You will review financial records...Remote workClaimsPermanent employmentFull timePart timeWork experience placementSecond jobFlexible hoursShift work
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