Remote RN/LPN Claims Auditor - Fraud & Compliance
WPS Health Solutions
- Remote job
WPS Health Solutions, a not-for-profit health insurer and DoD contractor, seeks a Claims Examiner III LPN to safeguard MVH program integrity. The role blends nursing expertise with data analysis to assess medical necessity, detect unusual utilization, and ensure compliant benefits administration. Remote work options are available with state approvals. The position requires U.S. citizenship, RN or LPN licensure, and 3+ years of clinical practice. #J-18808-Ljbffr WPS Health Solutions
- WPS Health Solutions seeks a Claims Examiner III LPN/RN to protect the MVH program by identifying, investigating, and preventing potential fraud, waste, and abuse. You will blend clinical... ...clinical practice. The position offers remote work options within approved states...Remote jobClaimsFraudContract work
- WPS Health Solutions seeks a Claims Examiner III LPN/RN to safeguard the MVH program by auditing claims... ...integrity. Join a team focused on preventing fraud, improving audit quality, and... ...with internal and external partners. Remote work options are available in multiple...Remote jobClaimsFraudFlexible hours
- ...compensation, and clinical compliance. Marwood operates at the... ...Certified Coding Auditor to work in its New York office or remotely. Principal duties and... ...regulations, applicable fraud statutes, and regulations... ...both UB-04 and CMS 1500 claims data, as well as understanding...Remote workClaimsFraudWork at officeLocal area
- ...program integrity through compliance management. Here, you'... ...to review and audit claims, supportprogram integrity... ...Registered Nurse (RN) license Strong clinical... ...vulnerable populations Remote work - enjoy the... ...and identify potential fraud, waste, or abuse. Review...Remote workClaimsFraudFull timeTemporary workWork at officeWork from home
$55k - $75k
...commercial clients in compliance and program integrity efforts... ...and detection of fraud, waste and abuse in government... ...role, the Medicaid Auditor will be responsible for... ...in reviewing claims for appropriate billing... ...screening checks. For remote work, required to have...Remote workClaimsFraudFull timeContract workTemporary workFor contractorsWork at officeLocal areaFlexible hours- ...Compliance Auditor The Compliance Auditor is responsible for ensuring the... ...action plans to prevent fraud, abuse, and compliance risks... ...regulations, including false claims act, stark law (self-referral... ...rotate working in the office and remote/telework May involve high...Remote workClaimsFraudWork at officeLocal area
$50 - $60 per hour
...is seeking an Attorney Auditor to join our team. You'll... ..., reasonableness and compliance with agreed upon fee structure... ...with law firms and claims staff to determine the... ..., and identity & fraud protection ~24/7 Employee... ...: Hybrid or fully remote in Princeton, NJ 08540...Remote workClaimsFraudHourly payPart timeWork at officeLocal areaWork visaFlexible hours- WPS Health Solutions is seeking a Claims Examiner III LPN to protect MVH program integrity by identifying... ..., and preventing potential fraud, waste, and abuse. This role blends clinical... ...with leadership and external partners. Remote work options are available for...Remote jobClaimsFraud
$145k - $175k
...more, visit Location: Remote (with ability to travel... ...The Habitat Health Compliance Manager has oversight for... ...Registered Nurse (RN) License. Experience... ...Beware of Scams and Fraud Habitat Health is... ...suspicious communications claiming to represent Habitat Health...Remote workClaimsFraudContract workTemporary workFixed term contractLocal areaFlexible hours$29 - $52 per hour
...Program Integrity Clinical Compliance Auditor Optum Insight is... ...of healthcare fraud and/or wasteful and abusive... ...providers who submit claims for payment. This position... .... This position is Remote in Massachusetts. You... ...~ Nurse licensure (RN or LPN) with a current, active...Remote jobClaimsFraudHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work$1,830 - $1,970 per week
...Registered Nurse Auditor (RN Auditor) – Remote Insurance Payer Audits Join our healthcare team as a remote... ...audits, denial management, billing compliance, and charge capture validation. This... ...RN with healthcare revenue cycle and claims review expertise. The ideal candidate...Remote workClaimsWeekly payFull timeLocal areaWork from homeShift work$74k - $135k
...coding and billing audits, disputes, claims analysis, investigations, compliance reviews, and litigation support.... ...reimbursement, contractual, regulatory, and fraud, waste, and abuse risks from... ...clearly in writing and verbally.An active RN license, another clinical credential...ClaimsFraudFull timeContract workLocal areaFlexible hours- ...HEDIS Auditor RN/LPN Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional... ...depending on how quickly candidate catches up. There is weekly onsite meeting which candidate must attend and remote other days....Remote workContract workWork from home
- Optum in the United States is seeking a Clinical DRG RN auditor to apply MS-DRG/APR-DRG coding expertise to inpatient claims. You will validate ICD-10 coding, DRG assignments, and discharge statuses, producing clear rationales and supporting audit findings. You can telecommute...Remote jobClaims
- TalentLNX LLC seeks a remote Clinical Claims Review RN to audit hospital claims line by line against medical records, ensuring charges are ordered, documented, and supported. The role blends acute care nursing judgment with chart auditing, coding, and revenue integrity...Remote jobClaims
- UnitedHealth Group's Optum unit is hiring a Clinical DRG RN auditor. You will apply MS-DRG/APR-DRG knowledge, ICD-10 guidelines, and AHA guidelines to audit inpatient claims and identify overpayments. This remote role allows telecommuting from anywhere in the U.S. with...Remote jobClaims
- ...Registered Nurse (RN) | Med/Surg / Telemetry Location: Burlington... ...patient population Perform remote telemetry monitoring; on-unit... ...5–1:6 required Must pass a compliance EKG exam prior to placement (2... ...on the Florida Diploma Fraud Audit list will not be accepted...Remote workFraudWeekly payFull timeContract workTemporary workImmediate startNight shiftWeekend work
- Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix® technology... ...Fault injuries. Job Title: Precertification Nurse - LPN/RN Full time: Monday to Friday Location: Remote. Will need to be in Hamilton NJ office for training...Remote jobClaimsFull timeWork at officeMonday to Friday
- ...Senior Medical Coding Outpatient Auditor to lead coding-focused audit... ...coding accuracy, and ensure compliance with outpatient coding and... ...The role involves researching claims anomalies, applying CPT/HCPCS... ...to improve audit strategies. Remote work with occasional travel is...Remote workClaims
$78.91k - $105k
...of hospital inpatient claims and related inputs. Determines... ...facilities are in compliance with industry billing... ...billing coordinator and/or auditor. # Certified... ...claims preferred. # RN licensure required, BSN... ...connection required to support remote or hybrid work. Must be...Remote workClaimsHourly payFull timeWork at officeWork from homeAfternoon shift$21.78 per hour
...Defense restrictions. Our Claims Examiner III LPN protects the... ...preventing potential fraud, waste, and abuse. They... ...role helps maintain compliance and strengthens trust... ...Location We are open to remote work in the following... ...Licensed Registered Nurse (RN): Associate Degree in...Remote workClaimsFraudContract workFor contractorsLocal areaImmediate startMonday to FridayFlexible hoursShift work- ...Coding Auditor Department: SIU Employment Type: Full Time... ...direct supervision of Healthcare Fraud Shield SIU management, this position... ...and codes billed on a claim to a medical record. Compare... ...career development initiatives ~ Remote work eligible REMOTE WORK...Remote workClaimsFraudHourly payFull timeFlexible hours
- Utilization Review Nurse Auditor (33034)# Utilization... ...Auditor (33034)Fully Remote • Mount Laurel, NJ 080... ...that all work is in full compliance with client... ...law firms, third-party claim administrators and government... ...time off, and 401k.******RN******LPN******LVN******CPCCPMA*...Remote workClaimsLocal areaMonday to Friday
$35 - $63 per hour
...this position as a Clinical DRG RN auditor , you will apply your expert... ...in the auditing of inpatient claims. Employing both industry and... ...Demonstrate knowledge of and compliance with changes and updates to... ...Ability to work independently in a remote environment and deliver...Remote workClaimsHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal area- Molina Healthcare is seeking a Senior Claims Examiner in the United States (Florida) to provide... ...for incorrect coding, abuse, fraud, waste, overpayments, and processing errors... ...investigation or resolution, and ensuring compliance with regulations across multiple lines of...ClaimsFraud
- ...Corporation is seeking an investigator to conduct fraud, waste, and abuse (FWA) investigations by reviewing referrals, claims data, and medical records to identify... ...investigations, preparing reports, and collaborating with compliance, legal, and external agencies to support...Remote workClaimsFraud
- ...Health is seeking a Certified Coding Analyst to perform medical claim reviews, audits, and documentation assessment to ensure compliant... ...Medical Directors, and identify potential billing errors or fraud. AAPC CPC certification and 2+ years of experience are required....ClaimsFraud
- ...Examining financial records for compliance and accuracy, the full-time Premium Auditor will conduct audits for dedicated customers remotely, ensuring adherence to laws and regulations while identifying potential fraud. Key responsibilities: Handle premium audits for dedicated...Remote workFraudFull time
- ...activities, the full-time Healthcare Fraud Investigator will focus on... ..., and abuse, while working remotely. Key responsibilities... ...and external review, ensuring compliance with regulations Coordinates... ...care, Medicaid, Medicare, and claim billing codes Proven investigatory...Remote workClaimsFraudFull time
- ...Conducting fraud, waste, and abuse investigations, the full-time... ...Investigator will review referrals, claims data, and medical records to... ...various stakeholders in a remote setting. Key responsibilities... ...actions Maintains compliance with federal and state regulations...Remote workClaimsFraudFull time
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