Senior Medical Claims Auditor
Highmark Health Company
Highmark Inc. is seeking a claims auditor with 5+ years of medical claims processing experience to ensure accurate auditing in line with CPT, HCPCS, ICD9 and ICD10 coding. You will monitor audits, document results, and train staff while maintaining high quality standards. The role requires strong communication, problem solving, and the ability to work independently or as part of a team in a fast-paced environment. Prior experience with system upgrades and audits is a plus. #J-18808-Ljbffr Highmark Health Company
- ...Division in the New Castle County office as a Senior Auditor. We seek an individual with a strong... ...cases brought under the Delaware False Claims and Reporting Act. The criminal cases... ...activity throughout the Delaware Medicaid and Medical Assistance Program, and other State and...SeniorMedicalClaimsWork experience placementWork at officeRemote work3 days per week
$79.7k - $105.48k
...policies. Job Summary The Compliance Auditor is responsible for conducting coding,... ...standards. This position focuses primarily on Medical Oncology, Radiation Oncology and Urology... ...The Compliance Auditor performs detailed claim reviews, identifies coding and...MedicalClaimsFull timeTemporary workLocal areaImmediate startRemote workFlexible hours$71.1k - $97.8k
...Become a part of our caring community The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records... ...experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a...MedicalClaimsBi-weekly payFull timeContract workTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday$53k - $81k
Position Title: Coding and Billing Auditor Location: Dover, DE Pay Range: $53,000.00 - $... ...detailed data quality reviews of provider medical records to ensure accurate ICD-10 and CPT... ...experience coding professional claims in a medical office-based setting Experience...MedicalClaimsFull timeWork at office$21.96 per hour
...list of all duties required of this position. ADA E1. Ensure all claims are handled according to all internal operating and... ...Required Education: HS/GED: Required Experience: 5 years prior medical dental, vision, FSA and HRA claims processing experience. Preferred...MedicalClaimsFor contractorsTraineeshipLocal area$59.3k - $80.9k
...of our caring community Humana is looking for an experienced medical coding auditor to handle provider disputes in a result-oriented and metrics... ...work experience reading and interpreting Behavioral Health claims 3+ years' experience performing Behavioral Health coding audits...MedicalClaimsBi-weekly payFull timeTemporary workApprenticeshipWork experience placementWork at officeRemote workWork from homeHome officeFlexible hours- ...auditing experience is preferred. seeking a certified professional coder with significant experience in coding professional claims in a medical office-based setting. Experience with coding different specialties is preferred. Looking for a candidate who has interacted regularly...MedicalClaimsWork at office
$41.2 - $62.17 per hour
...: The Revenue Integrity RN Charge/Coding Auditor is responsible for consulting on clinical... ...Auditor will execute clinical charge audits of medical records on behalf of Intermountain... ...Demonstrates in depth knowledge of the healthcare claim denial process. Demonstrates clear...MedicalClaimsHourly payFull timeWork at officeRemote workFlexible hours- Summary Provides medical collection services for TLRA collection units. Utilizes a strong background as a medical collection specialist... ...pending information, and any other issues that impact and/or delay claim processing. Collections - Self Pay Ensures that self-pay...SeniorMedicalClaimsFull timeContract work
$60k - $90k
Senior Mainframe - Remote Cognizant is seeking an experienced Senior Mainframe with 7+ years... ..., mainframe technologies, and Healthcare Claims processing. The ideal candidate will lead... ...to applicable eligibility requirements: Medical, Dental, Vision, and Life Insurance Paid...SeniorMedicalClaimsRemote jobTemporary work$104k - $143k
...Become a part of our caring community The Senior Research Scientist applies statistical, epidemiologic, and causal inference... ...for decision-making. Conduct deep-dive analyses using medical and pharmacy claims, enrollment, and operational data to identify key...SeniorMedicalClaimsFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome office$89k - $121.4k
...Become a part of our caring community The Senior Business Intelligence Engineer supports... ...healthcare data, including familiarity with claims-related or operational data. Experience... ...work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k)...SeniorMedicalClaimsBi-weekly payFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome office$750 per month
...The Sr. Account Executive (Sr. AE) is a senior level individual contributor responsible... ...Upsell value added programs such as AGS, medical carveouts with Archimedes products, and clinical... .... Translate complex reporting, claims adjudication concepts, and clinical insights...SeniorMedicalClaimsWork experience placementRemote workFlexible hours- ...is seeking an experienced Outpatient Behavioral Health Coding Auditor to join the Disputes Team in a remote work setup. The role focuses... ...compliant dispute outcomes. You will review Behavioral Health claims, apply coding guidelines, and communicate results clearly to...ClaimsRemote job
- Delaware Department of Justice seeks a Senior Auditor to support the Medicaid Fraud Control Unit in the Fraud & Consumer Protection Division. The role focuses on auditing and data analysis for civil and criminal health care fraud investigations, including multijurisdictional...SeniorRemote job
- A-Line Staffing Solutions is hiring a Coding and Billing Auditor in Dover, DE. The role involves auditing medical records for accurate ICD-10 and CPT coding and educating providers on documentation standards. Candidates must have a Certified Professional Coder (CPC) certification...MedicalFull time
- Cognizant is seeking an experienced Senior Mainframe with 7+ years in MQ, mainframe technologies, and Healthcare Claims processing. The role leads design, development, and optimization of MQ-based messaging and Claims applications, partnering with onsite and offshore teams...SeniorClaimsRemote job
- ...As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will provide an interpretation of the medical necessity of services provided...MedicalClaimsExtra income
$105.79k - $141.05k
...ready connectivity, join us today. The Role We are seeking a Senior Lead Technical Marketing Manager to shape how Lumen brings its... ...while maintaining accurate, evidence-based, and brand-safe claims. Drive cross-functional execution: Lead complex workstreams without...SeniorClaimsFull timeTemporary workWork from home- ...might have the career for you. Care to talk? Bayhealth Medical Center is Central and Southern Delaware's healthcare leader... ...for following up on all hospital and/or professional insurance claims. The position requires advanced knowledge of all payers and claim...MedicalClaimsFull timeContract workShift work
$81k
...Job Description Job Description Medical Coding & Billing Auditor (CPC Required) – $81K | Full-Time | On-site | Dover, DE We are currently hiring an experienced Medical Coding & Billing Auditor for a full-time permanent opportunity in Dover, Delaware. This role...MedicalPermanent employmentFull timeCurrently hiringWork at officeDay shift- ...career path in the healthcare industry? Use Dreambound to find a Medical Billing and Coding program that will prepare you for this high-... ...billing and coding specialist processes and codes healthcare claims to ensure accurate billing and insurance reimbursement, supporting...MedicalClaimsRemote work
- Intermountain Health is seeking a part-time RN reviewer to perform remote medical record abstraction for HEDIS audits. You will review charts from provider offices using a proprietary tool to ensure documentation supports CMS and STARS measures. You will collaborate with...MedicalRemote jobPart timeFlexible hours
- CHRISTUS Health is seeking a Medical Collections specialist in Louisiana to manage follow-up and resolution of TLRA accounts. The role involves contacting patients, clients, and vendors while complying with state and federal guidelines. Prior experience in healthcare billing...SeniorMedical
$90.8k - $136.2k
...benefits package, WWT has one of the best. We offer the following benefits to all full-time employees: Health and Wellbeing: Health (Medical & Prescription), Dental, and Vision Care, Onsite Health Centers (MO & IL), Employee Assistance Program, Wellness program...SeniorMedicalFull timeFlexible hoursShift work- ...delivering a compassionate and professional client experience. Claims & Insurance Coordination: Initiate insurance claims, verify coverage... ...& File Management: Gather intake information, collect medical records, bills, wage loss documentation, and other supporting evidence...MedicalClaimsFull timeTemporary workWork at officeMonday to FridayFlexible hours
$35.22 - $53.29 per hour
Fully Remote SelectHealth - Murray Part time R189337 Job Description To review medical records retrieved from provider offices and abstract medical information for HEDIS (Health Effectiveness Data Information Set) annual audits. Interprets relevant clinical criteria through...MedicalHourly payPart timeWork experience placementReliefWork at officeLocal areaRemote workFlexible hours- Cardinal Health is seeking an Account Manager to nurture a portfolio of Medical Products and Distribution customers across the United States. You will lead service delivery, identify upsell opportunities, and coordinate across internal teams to ensure seamless order fulfillment...SeniorMedical
- ...portfolio priorities. It will establish tooling, metrics and automation practices, and require day-one onsite onboarding with a personal laptop. The position is remote with a W2 arrangement and benefits including medical, dental, and vision, #J-18808-Ljbffr Eliassen GroupSeniorMedicalRemote job
$169.8k - $355.4k
...preceding factors as well as internal peer equity. Oracle US offers a comprehensive benefits package which includes the following: # Medical, dental, and vision insurance, including expert medical opinion # Short term disability and long term disability # Life...SeniorMedicalTemporary workFlexible hours
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