Claims Auditor & Process Improvement Specialist
South Florida Community Care Network Llc
South Florida Community Care Network LLC in Sunrise, FL is seeking a full-time Claims Analyst to support accurate and timely claims payment through pre-payment audits, analysis, and payment integrity activities. You will review professional and facility claims, identify discrepancies, and work with internal teams to resolve issues and improve processing. The role requires 5–7 years of claims experience (Associates preferred) and knowledge of ICD-10-CM, CPT, DRG coding, and fee schedules. #J-18808-Ljbffr South Florida Community Care Network Llc
- ...will have a strong understanding of medical claims billing, denial management, and insurance... ...teams to resolve billing issues and improve revenue cycle performance. Travel Requirements... ...feedback to management regarding process improvements and challenges. Ensure compliance...Process improvementClaimsWork at officeShift work
- We are seeking an experienced Claims Center Business Analyst with a strong background in... ...to gather requirements, define business processes, and support implementation and... ...recommendations for system enhancements or process improvements. Assist in incident investigation, root...Process improvementClaims
- ...to ensure maximum reimbursement is received for physician billing. The ideal candidate would have a strong understanding of medical claims billing. This individual will also be responsible for researching and resolving claims denials, monitor that all denied claims are...ClaimsWork at office
- ...impact? We are seeking a dedicated and detail-oriented Subrogation Specialist to join our dynamic law practice. In this vital role, you will be responsible for managing and processing insurance claims efficiently and effectively. You will act as a liaison between clients...ClaimsBi-weekly payHourly payFull timeMonday to Friday
- ...office presence and oversight of daily unit operations across cash receipts, cash application, claims audits, and related areas. You will lead a team, drive process improvements, and collaborate with Sales, Underwriting, Claims, and Member Services to ensure accurate...Process improvementClaimsWork at office
$90k - $115k
...Jobot? Click our Jobot logo and follow LinkedIn page! Senior Auditor / Great Place To Work! Jobot Job is hosted by: Jay O'Brien... ...presenting audit findings, and providing recommendations for process improvement. This role requires a high level of integrity, the ability to...Process improvementPermanent employmentWork at office$27 per hour
...Job Description Job Description Job Title: Reimbursement Specialist Location: Sarasota, FL Job Type: 3+ month Temp Pay Rate: $27.00/hr+... ...for assigned payers. The Reimbursement Specialist will monitor claim status, research rejections and denials, perform necessary follow...ClaimsFull timeTemporary workWork at office- ...Subrogation Claims Specialist The position plays a vital role in identifying and pursuing subrogation opportunities within workers’ compensation claims across Florida and other designated jurisdictions. The successful candidate will be responsible for conducting thorough...Claims
- ...A healthcare organization is seeking a Revenue Cycle Specialist responsible for ensuring timely billing, collection, and payment of healthcare claims. The candidate will review claims, resolve discrepancies, and collaborate with various departments to maximize reimbursements...ClaimsWork at office
- Serve as a Corporate EHS Auditor and Subject Matter Expert (SME) as requested to support... ...Team, helping develop and optimize lean processes for Jabil Corporate EHS Assessments. Support... ...a roadmap for continual maturity improvement. Maintain EHS management system documentation...Local area
- ...Preferred Experience with benefit setup in a PBM system Familiarity with health plan or TPA operations Process improvement or documentation experience Prescription claims adjudication experience Benecard Services, LLC has been administering carve‑out, fixed rate insured...Process improvementClaims
- Insurance Services Group of the Southeast, Inc. (ISG) is seeking a skilled auditor to join our market-leading premium audit team. The role focuses on workers' compensation and general liability audits across diverse clients. You will apply knowledge of state, NCCI, and...
- ...warranty project management activities for our power generation fleet. The role provides hands-on experience in warranty claim administration, process improvement, project coordination, and data analysis, working with the Warranty Project Manager and cross‑functional teams....Process improvementClaims
$75k - $90k
...schedule. Your Opportunity Behind every clean claim and resolved denial is a patient who can... ...work, providing feedback and coaching to improve accuracy and clean claim rates. Monitor... ...follow‑up across the team's accounts. Process & Compliance Develop and maintain documented...Process improvementClaimsPrivate practiceRemote workWork from home- ...Sanitas is seeking a Revenue Cycle Specialist in Miami Dade, FL to support daily revenue cycle operations, analyze billing data, investigate denial trends, and process claim corrections to optimize reimbursement rates. The role involves generating reports from the EHR...Claims
$31.2 - $40.56 per hour
...coders, clinical department and/or physicians for documentation improvement on a monthly, quarterly and on an as needed basis. Create consistency and efficiency in outpatient or inpatient claims processing and data collection to optimize APC, ASC or DRG reimbursement. Estimated...ClaimsRemote jobLocal area- ...while also assisting with documentation improvement, audits, and quality initiatives across... ...trends in documentation issues and suggest process improvements Collaborate with coding,... ...billing, and clinical staff to support clean claims Collaborate and assist our...Process improvementClaimsFull timeWork at office
- ...Inc. is seeking a Senior Accounts Receivable Specialist to manage and optimize vendor receivables and MDF claims, ensuring timely submission and accurate tracking... ...controls, with opportunities to influence process improvements and audit readiness. A competitive base...Process improvementClaims
- ...wholesalers. Key Responsibilities Review, validate, and process chargeback submissions. Approve or reject claims based on contractual terms. Reconcile chargebacks... ...chargebacks and deductions. Identify process improvements and maintain compliance with internal policies. Qualifications...Process improvementClaimsContract workWork at office
- ...matters from inception through resolution, including proofs of claim, motions for relief from stay, plan review and objections,... ...culture. Committed to delivering quality work, identifying process improvements, and providing exceptional client service. #J-18808-Ljbffr...Process improvementClaimsWork at officeLocal areaRemote work
- ...utilities damages and ensure accurate damage claims production for our Power and Gas... ...combines leadership with hands-on damage specialist duties across markets. You will supervise field damage specialists, drive process improvements, and work with clients to integrate PRG...Process improvementClaims
- Billing and Coding Auditor Banyan Treatment Centers is seeking a detail-oriented and experienced Billing and... .... This critical role ensures the integrity of our claims processes and supports continuous quality improvement, staff education, and adherence to payer regulations...ClaimsFull timeWork experience placementWork at officeRemote workFlexible hours
- ...will ensure smooth patient admissions by collecting accurate demographic and insurance information to support coding, billing and claims submission, while greeting patients professionally. The role emphasizes efficiency, courteous service, and attention to detail, including...Claims
- ...2) years of experience working within a Claims Operations environment highly preferred.... ...supporting Medicare Fee-for-Service (FFS) claims processing strongly preferred. Demonstrated... .... Proven ability to identify process improvement opportunities and drive standardization...Process improvementClaims
- Humana Inc. is seeking a Process Improvement Professional2 to identify opportunities that improve outcomes, strengthen compliance, and enhance operational effectiveness across healthcare programs, including long‑term care. You will analyze cross‑functional inputs, map processes...Process improvementRemote job
- ...verifiable. Please attach any credentials you claim (degree, certifications, etc.) to your... ...completion of the due diligence process to include, but not limited to, a Level... ...Veterans' Nursing Home. The Food Control Specialist (FCS) may act as the Food Service Administrator...ClaimsTemporary workMonday to FridayWeekend work
- ...review and evaluate medical necessity, appropriateness, quality, and compliance of services rendered by providers. The role covers claims analysis, provider audits, fraud detection, and regulatory enforcement to ensure state and federal compliance. The RN will analyze...ClaimsRemote job
- ...compassion, respect, and kindness.” Job Summary The Revenue Cycle Specialist supports the daily operations of the revenue cycle department, analyzing billing data, investigating denial trends, and processing claim corrections, in order to optimize reimbursement rates, ensure...ClaimsContract work
- ...premium paid by the State, and So Much More! ***Other Food Control Specialist positions, including OPS (Temporary) positions, may be filled... ...for postsecondary educational requirements. Candidates claiming Veterans’ Preference must attach supporting documentation with...ClaimsTemporary workMonday to FridayNight shiftWeekend work
- Molina Healthcare in New York is seeking a Claims Support Specialist to assist with researching and resolving member and provider inquiries, including... ...to inquiries, and document findings while ensuring timely processing of claims and adherence to state and federal guidelines....Claims
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