Remote Clinical Provider Auditor I - Claims & Compliance
Elevance Health
- Remote job
Elevance Health is seeking a Clinical Provider Auditor I responsible for identifying potential fraud and abuse risks. This role works virtually full-time, with occasional in-person training. Candidates must have at least a AA/AS degree and 1 year of medical coding/auditing experience. Key responsibilities include examining claims for compliance, analyzing medical records, and collaborating with the Special Investigation Unit. Competitive benefits include merit increases, paid time off, and health insurance. #J-18808-Ljbffr Elevance Health
- The Elevance Health Companies, Inc. is seeking a Clinical Provider Auditor I for a virtual, full-time role. The position involves examining claims for compliance, reviewing medical records, and collaborating with various teams. To qualify, candidates should hold an Associate...Remote jobClaimsFull time
- Elevance Health is seeking a Clinical Provider Auditor I responsible for identifying potential risks associated with fraud and abuse. This position allows for virtual work but candidates must be within commuting distance of an office location. The ideal candidate will have...Remote jobClaimsWork at office
- ...Health in Grand Prairie, Texas seeks a Clinical Provider Auditor II focused on payment integrity. This role involves examining claims for compliance and preventing fraud, collaborating... ...position offers a mix of in-office and remote work options, promoting flexibility and...Remote workClaimsWork at office
$80k - $90k
...Responsibilities*** Performs clinical reviews on medical... ...research, analyzes claims data, applies knowledge... ...to support findings.* Provides correction to... ...-harassment and other compliance and policy/procedures... ...work independently in remote setting with minimum supervision...Remote workClaimsFlexible hours$29 - $52 per hour
...This position is remote in Massachusetts.... ...alignment between care providers and payers, and... ...responsible for performing compliance reviews of medical... ...who submit claims for payment. This... ...applicable, the Auditor will support appeal... ...documentation in a clinical or administrative...Remote jobClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work- ...for a detail-oriented Registered Nurse Clinical Auditor to support medical record reviews and billing compliance audits for the Indiana Health Coverage... ...certification, and at least 1 year of Medicaid claims review experience. This remote position requires occasional travel...Remote jobClaims
$58k - $114.9k
...Remote MSDRG Auditor Category: Analytics and Emerging Digital... ...the CGI Healthcare Compliance, DRG Validation Team,... ...and reimbursement for clinical services rendered to... ...underpayments) on paid claims on behalf of the client from various providers of clinical services,...Remote workClaimsFull timeContract workWork at officeLocal area- ...hybrid (3 days on site, 2 remote) Key Functions 1.... ...progress notes, other clinical documentation to determine services provided are assigned accurate coding... ...to ensure compliance with third party and regulatory... ...improve the processing of claims, collections of...Remote workClaimsMonday to FridayShift work
- ...large businesses as well as providing information and tools to help... ...classified as hybrid, onsite or remote. While the majority of our... ...limited to: Customer Service, Claims Processors, and Correspondence... ...developing and delivering clinical curriculum, developmental programs...Remote workClaimsFull timeWork experience placement1 day per week
$59.3k - $80.9k
...The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding... ...documentation for clinical indicators to ensure... ...peer reviews to ensure compliance with coding guidelines... ...WORK STYLE: Remote, work at home. While...Remote workClaimsBi-weekly payFull timeContract workTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday$45.67 per hour
Auditor Clinical Validation Outpatient Specialty Clinical Job Locations US-Remote ID 2026-18743 Category Audit - Healthcare... .../specialty claims and documenting the... ...billing/payment systems provider billing guidelines,... ...other regulatory compliance guidelines and...Remote workClaimsHourly payFull timeContract workWork at officeImmediate start$30.46 - $45.69 per hour
...factors. Billing Compliance, Senior Auditor Reporting to the... ...resolve risks affecting claim payment, in... ...with administrative and clinical leadership. Position... ...Hybrid (Evanston, IL and remote) Full Time/Part... ...system committed to providing access to quality, vibrant...Remote workClaimsHourly payFull timeContract workPart timeFor contractorsMonday to Friday- Elevance Health is seeking a Clinical Provider Auditor II in Atlanta, Georgia. This hybrid role requires 1‑2 days a week in the office, promoting... ...to fraud and abuse through examination and analysis of claims. Minimum qualifications include an AA/AS degree, a coding certification...ClaimsWork at office2 days per week1 day per week
- The Elevance Health Companies, Inc. is seeking a Clinical Provider Auditor II in Atlanta, Georgia. This role involves identifying potential fraud and abuse risks through thorough claims analysis and teamwork with the Special Investigation Unit. Candidates will need an...ClaimsWork at office
- ...Clinical Auditor/Analyst Position UPMC Health Plan has an exciting opportunity... ...hours and will be a remote position. The Clinical Auditor... ..., prepayment review of claims, and prepayment review of unlisted... ...; analysis of billing by providers/physicians, and providing...Remote jobClaimsFull timeWork at officeLocal areaMonday to Friday
- ...Clinical Auditor Registered Nurse We are seeking a detail... ...reviews, billing compliance audits for the Indiana... ...writing skills. This is a remote position with... ...documentation to evaluate provider compliance with Indiana... ...1 year of Medicaid claims review, billing compliance...Remote workClaimsLocal area
- Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1-2 days per week, fostering... ...associated with fraud and abuse, and for assessing claims for compliance with billing and processing guidelines. Examines claims...ClaimsWork at officeLocal areaDay shift2 days per week1 day per week
$68.02k - $108.82k
...Auditor, Provider Data Join Us in this Amazing Opportunity... ...requirements and claims processing. Finally,... ...ensure accuracy and compliance for programs, including... ...0, 505 Building or a remote work location: Work... ...typically indoors in a clinical setting serving the frail...Remote workClaimsContract workTemporary workWork at officeLocal areaFlexible hoursWeekend workAfternoon shift2 days per week- A leading healthcare provider in New York seeks a Clinical Revenue Auditor to ensure the accuracy of medical billing and compliance with regulations. Ideal candidates will have 3-5 years... ...-time role offers the option to work remotely or in a hybrid setting, contributing...Remote jobFull time
$35 - $62.5 per hour
...Clinical DRG RN Auditor $10,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS... ...of inpatient claims. Employing both industry... ...Demonstrate knowledge of and compliance with changes and... ...on quality Provide clinical support and... ...work independently in a remote environment and deliver...Remote jobClaimsHourly payDaily paidMinimum wageFull timeTemporary workPart timeWork experience placementWork at officeLocal areaRelocation package- ...Texas Health Institute is seeking a Clinical DRG RN auditor who will leverage expertise in MS-DRG and APR-DRG coding to audit inpatient claims. This role entails validating ICD-10 codes and DRG assignments while working remotely from anywhere in the U.S. The ideal candidate...Remote workClaimsRelocation package
- ...Business Analyst - Clinical Analyst & Coding Specialist... ...Location: Fully Remote Interview Process... ...policy, coding analysis, claims processing, and MMIS... ...supporting medical coding compliance, coding updates,... ...replacement project meetings, providing coding and business...Remote workClaimsContract workWork at officeRelocation
- ...Clinical Quality Assurance Coordinator (29934) job at... ...quality, integrity, and compliance with client agreements... ...Role Rocks ~100% Remote – Enjoy the flexibility... ...rationales have been provided in support of all recommendations... ...industry preferably claims management relative to...Remote workClaimsLocal areaWork from homeMonday to FridayWeekend work
$35 - $40 per hour
...Clinical Quality Assurance Supervisor Salary Range... ...passionate about quality, compliance, and driving... ...Assurance team in a fully remote environment. In this role... ...rationales have been provided in support of all recommendations... ...industry preferably claims management relative to...Remote workClaimsHourly payFull timeLocal areaWork from homeMonday to FridayWeekday work- ...Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To:... ...operations by reviewing denied claims for clinical accuracy... ..., and ensuring compliance with payer policies and... ...preparation and provide clinical insight when...Remote workClaims
$80k
...Medical Program Integrity Auditor Minimum Salary... ...onsite audits across various provider types to ensure compliance with federal and state regulations... ..., including data mining, claims analysis, and medical... ...other aspects of the job are remote. Responsibilities...Remote workClaimsFull timeWork at officeShift work- ...J29, Inc is seeking a part-time Physician Auditor to perform blinded Independent Review clinical evaluations while adhering to Medicare guidelines. The position... ...familiarity with peer review processes. This is a remote position, creating a flexible work environment. #J-1...Remote workClaimsContract workPart timeFlexible hours
- ...Remote Medical Coding Auditor (CPC, CCS-P, or CPMA) Crossroads Treatment Centers... ...professionals dedicated to providing the most accessible, highest... ...Conducting audits of claims and patient records to identify... ...of findings and any compliance issues identified with audits...Remote workClaimsTemporary workMonday to FridayShift work
$90 per hour
...Remote Licensed Clinical Social Worker (LCSW) – Address San Jose, CA, USA • Compensation... ...families find the right provider covered by their health... ...support, EHR, audits, and compliance) so you can focus on... ...need to worry about unpaid claims Rula pays you even when...Remote workClaimsStart working today- ...Job Description The Auditor/Educator Inpatient Coding performs internal... ...coding assignments is in compliance with the official coding guidelines as supported by clinical documentation in health records... ...reimbursement methodologies and claims processing. Ability to develop...Remote workClaimsFull timeWork at office
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