Remote Medical Claims Auditor | AI‑Driven Prepay Audits
Clover Health
- Remote job
Clover Health is hiring a CPC with 3+ years of coding and auditing experience to review claims for billing and coding issues in collaboration with SIU and Clinical teams. The role leverages AI tools to flag anomalous patterns and support prepayment audits. The ideal candidate has strong CMS/CCI knowledge and Medicare coding expertise. This is a remote-first opportunity with competitive compensation and benefits from a fast-growing, mission-driven company. #J-18808-Ljbffr Clover Health
- Review claims for billing and coding issues... ...Clinical teams. Use AI tools to identify... ...and support prepayment audits. Who you are: CPC... ...flexible time off. Medical, dental, vision, parental... ...leave, and remote-first culture. Clover... ...startup with a mission-driven, collaborative...Remote jobMedicalClaimsFlexible hours
- ...Data Analytics and AI-driven platforms. Cybersecurity... ...This is a remote position. RN Clinical Auditor - Behavioral Health... ...experience to support medical record reviews and billing compliance audits for the Indiana Health... ...within psychiatric/BH claims Maintain detailed workpapers...Remote workMedicalClaimsContract work
- ...expert, compassionate medical care team at 11 hospitals... ...As a Coding Auditor, you will be a central... ...resolving medical coding claim defects before billing.... ...problem-solving approach, driven by a commitment to maximizing... ...efficiency. As a remote employee, we will provide...Remote workMedicalClaimsWork at officeWork from home
$67k - $76k
...Why Join Us? Mission-Driven Work: You are the "... ...Work Arrangement : Remote Compensation Range... ...: As our next Medical Coding Auditor , you will be responsible... ...for reviewing and auditing documentation and coding... ...platforms and claim workflows—how coding...Remote workMedicalClaimsFull time- Optum is hiring a Medical Coding Auditor to verify claims against medical records and ensure compliance with coding guidelines. This telecommuting... ...providers and internal teams to maintain quality and production metrics in a remote, production-driven #J-18808-Ljbffr OptumRemote jobMedicalClaims
- ...seeking an experienced Inpatient Medical Coding Auditor to review inpatient hospital claims for proper reimbursement,... ...provider disputes in a results-driven setting. This remote role may require occasional... ...certification, MS-DRG coding/auditing experience, and the ability to...Remote jobMedicalClaims
- Centene Corp. seeks a seasoned claims auditor to conduct comprehensive retrospective and prepayment reviews of medical records supporting claims... ...medical necessity. This remote role requires an active behavioral... ...in utilization management, auditing and fraud, waste and abuse...Remote jobMedicalClaims
- UnitedHealth Group is seeking a Medical Coding Auditor to review CPT/HCPCS codes and modifiers on telecommuting claims. You will determine accuracy of coding, provide detailed... ...experience, and the ability to work in a metric-driven, team-based environment. #J-18808-Ljbffr...Remote jobMedicalClaims
- ...collaborative, ownership-driven culture, CGI... ...Outpatient Coding Auditor to join our Healthcare Compliance Audit Team. In this role,... ...conduct comprehensive medical record audits and... ...underpayments. You will review claims across outpatient... ....This is a fully remote position open to...Remote workMedicalClaimsWork at officeLocal area
$71.1k - $97.8k
...Community The Inpatient Medical Coding Auditor extracts clinical... ...inpatient hospital claims for proper reimbursement... ...oriented and metrics-driven environment. If you... ...Work Style: Remote/work at home. While this... ...years) MS-DRG coding/auditing experience Experience...Remote workMedicalClaimsBi-weekly payContract workTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday$52.79k - $76.46k
...distinctive, values-driven platform dedicated... ...care for the most medically and socially complex... ...The Job The Claims Auditor will perform various audits of claims payments... ...are curious about AI and its power to transform... ...hour Work Mode: Remote Annual bonus...Remote workMedicalClaimsHourly payFull timeFor contractors$76k - $99k
...Clover's provider Network, Claims, and Tech teams. The... ...on reducing inappropriate medical spend. As an DRG Validation Auditor at Clover Health, you will... ...Additionally, we embrace a remote-first culture that... ...are passionate and mission-driven individuals with diverse...Remote workMedicalClaimsFull timeWork experience placementWork at officeFlexible hours$95k
...Overview This DRG Validation Auditor role is focused on our Cross Claim Clinical Reviews (CCCR).... ...DRG Validation for our prepay and retrospective audits and making determinations without a medical record. The ideal... ...candidate is selected. #LI-Remote #LI-JB1 #senior...Remote workMedicalClaimsHourly payFull timeReliefWork at officeImmediate startShift workNight shiftWeekend workAfternoon shift- Machinify is seeking a Medical Review Nurse II - Commercial DME to perform retrospective/prepayment audits on government and commercial payer claims. This remote role requires handling desk audits, documentation of findings, and supporting appeals in a fast-paced environment...Remote jobMedicalClaims
$28 - $33 per hour
...Company: Covet Health Location: Remote Reports to: Claims Supervisor Covet Health is a modern... .... We leverage technology and data-driven care pathways to improve healthcare delivery... ...such as reviewing Itemized bills, Medical Records, Authorization and members...Remote workMedicalClaimsPermanent employmentFull timeWork experience placementMonday to Friday- Machinify is seeking a Medical Review Nurse II - Commercial DME to perform retrospective and prepayment medical claims audits for Government and Commercial payers. This remote U.S. role joins a multi-location team of expert auditors and coders, delivering high-quality reviews...Remote jobMedicalClaims
$31.2 - $40.56 per hour
...Health is supported by philanthropy and driven by its faith-based mission of medical excellence.For 25 years, we've been... ...will be responsible for complex audits of clinically coded data to assess... ...in outpatient or inpatient claims processing and data collection to optimize...Remote jobMedicalClaimsLocal area- ForHealth Consulting at UMass Chan Medical School seeks an Auditor to identify, investigate,... ...conduct desk and onsite audits across provider types, using data mining and claims analysis to detect irregular... ...times per month; most work is remote with periodic site visits....Remote jobMedicalClaims
$90k - $105k
...and content-rich, AI-powered platform along... ...one of our other Medical Review Nurse roles... ...(SNF) medical claims audit reviews. As a MR Nurse... ...medical auditors performing retrospective and prepayment audits on claims for... ...Payers. You will work remotely in a fast-paced and...Remote workMedicalClaimsFull timeFor contractorsWork at office$24 - $43 per hour
...Medical Coding Auditor Optum is a global organization that delivers care, aided by technology to... ...required to determine the accuracy of claims submitted by a provider to UnitedHealth... ...and monthly metrics in a production driven environment and ensure they are meeting...Remote jobMedicalClaimsHourly payMinimum wageFull timeContract workWork experience placementLocal area$31.06 - $46.59 per hour
...Billing Compliance, Senior Auditor Reporting to the... ...by conducting routine audits and investigations related... ...reimbursement for medical services. The Senior Auditor... ...risks affecting claim payment, in partnership... ...Hybrid (Evanston, IL and remote) Full Time/Part Time:...Remote workMedicalClaimsHourly payFull timeContract workPart timeFor contractorsMonday to Friday- Billing and Coding Auditor Banyan Treatment Centers... ...integrity of our claims processes and supports... ..., FL), Hybrid or Remote (USA)Reports to:Auditing Manager & Director of... ...years of experience in medical claims billing and/... ...Part of a Mission-Driven Team:Contribute to compassionate...Remote workMedicalClaimsFull timeWork experience placementWork at officeFlexible hours
- Perform retrospective and prepayment audits on skilled nursing facility (SNF) claims for government and commercial payers. Work remotely in a fast-paced, dynamic... ...: Audit claims for medically appropriate services in... ...the company combines an AI-powered platform with best...Remote jobMedicalClaimsFor contractorsWork at office
$59.3k - $80.9k
...looking for an experienced medical coding auditor to handle provider... ...oriented and metrics-driven environment. If you... ...Leverages advanced auditing expertise to make coding... ...Behavioral Health claims 3+ years' experience... ...Travel: While this is a remote position, occasional...Remote workMedicalClaimsBi-weekly payFull timeTemporary workApprenticeshipWork experience placementWork at officeWork from homeHome officeFlexible hours$55k - $75k
...technology solutions, audit, investigation, and medical review. At... ...promotes corporate-driven sustainability. We deliver... ...role, the Medicaid Auditor will be responsible... ...Experience in reviewing claims for appropriate billing... ...checks. For remote work, required to have...Remote jobMedicalClaimsFull timeContract workTemporary workFor contractorsWork at officeLocal areaFlexible hours$38.61 - $55.86 per hour
...distinctive, values-driven platform dedicated... ...care for the most medically and socially... ...Care Services (DHCS) auditing team responsible for... ...delegated claims processing and the... ...are curious about AI and its power to transform... ...hour Work Mode: Remote/Field (This role requires...Remote workMedicalClaimsHourly payContract workFor contractorsLocal areaFlexible hours- ...and content-rich, AI-powered platform along... ...costs. The Medical Review Nurse II -... ...performs medical claims audit reviews. As a MR Nurse... ...experienced medical auditors and coders... ...retrospective and prepayment audits on claims for... ...Payers. You will work remotely in a fast paced and...Remote workMedicalClaimsFor contractorsWork at office
- ...IT Audit Manager Anywhere Type: Consulting... ...Workplace Type: Remote Standard Hours:... ...that includes Medical, Dental, and Vision... ...process owners, external auditors, and project... ...artificial intelligence (AI) tools as part of... ...meaningful outcomes. We are driven by a purpose to...Remote workMedicalHourly payLocal area
$35 - $63 per hour
...as a Clinical DRG RN auditor , you will apply your... ...Clinic Guidelines in the auditing of inpatient claims. Employing both... ...to ensure accuracy of medical coding and utilize clinical... ...that is matrix driven What are the reasons... ...independently in a remote environment and deliver...Remote workMedicalClaimsHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal area- ...healthcare consulting firm is seeking an experienced Medical Billing Specialist to handle claims processing and contribute to AI-powered tools for optimizing billing workflows... ...are essential. Join us to help enhance AI-driven medical billing solutions in a collaborative...Remote jobMedicalClaims
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