Medicaid Claims Auditor - Payment Integrity & Compliance
Cook Children's Health Care System
Cook Children's Health Care System is seeking a Claim Auditor to ensure monthly audits of adjudicated Texas Medicaid and CHIP claims, including paper and electronic submissions for payment integrity. The role involves performing routine and moderately complex audits across various service types, communicating results to the Claims Department, and delivering production and operational reports to the Director of Compliance each month. #J-18808-Ljbffr Cook Children's Health Care System
- ...leading healthcare solutions firm seeks a Payment Integrity Supervisor to oversee daily operations... .... The ideal candidate will also ensure compliance with healthcare auditing standards and... ...position requires strong experience in claims processing and excellent communication...ClaimsRemote jobDaily paid
- The Claim Auditor is responsible for ensuring that their assigned sampling... ...claims for Texas Medicaid and CHIP programs are audited... ...and electronic claims for payment integrity in alignment with regulatory... ...provided to the Director of Compliance at the end of each month....ClaimsWork at office
$70k - $75k
...Services & Insurance Attorney Auditor ** This is a fully remote... ...with law firms to discuss compliance with client's billing requirements... ...approve legal invoices for payment. Consistently meet company... ...the world's leading risk and claims administration partner, which...ClaimsLocal areaRemote workWork from homeFlexible hours$66.94k - $101.26k
...The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Reviews, analyzes, and completes internal...ClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaRemote workFlexible hours- The Payment Integrity Supervisor is responsible for the daily activities of payment integrity team related to quality assurance and provider... ...duties as assigned KNOWLEDGE & SKILLS: Strong understanding of claims processing, ICD-10 Coding, DRG Validation (if applicable)...ClaimsDaily paidMinimum wageFull timeWork experience placementWork at officeLocal areaRemote workFlexible hours
- A community college in Fort Worth, Texas is seeking an Account Auditor to assist with auditing claims and ensure compliance with policies and statutes. The position requires a Bachelor's degree in business and a year of relevant experience. Responsibilities include reconciling...ClaimsFull time
$73.35k - $113.25k
...Job Description Job Description The Payment Integrity Analyst (Team Lead) assists with... ...accurately reviewing pre and post pay claim audits based on client, policy, industry... ...Oversees team member work for quality and compliance and communicates deadlines and productivity...ClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaRemote workFlexible hours- ...of activities such as coordinating the compliance monitoring process, preparing compliance... ...Manages Auto Liability and General Liability claims, ensuring that reporting, correspondence... ...ability to handle sensitive issues with integrity. Keen attention to detail and extremely...Claims
- ...Accurately process and submit medical claims to insurance companies,... ...insurance appeals, ensuring compliance with payer guidelines.... ...regarding billing questions, payment responsibilities, and insurance... ...Experience with Medicare/Medicaid billing and commercial insurance...ClaimsContract workRemote work
- Summary Assists with the audit of claims presented for payment through accounts payable and ensures that... ...proper accounting procedures and compliance with state statutes, county policy and... ...entities including external auditors. Monitors and reconciles selected accounts...ClaimsFull timeWork experience placementFlexible hours
- ...service philosophy. Adheres to the FMCNA Compliance Program, including following all... ...insurance options (i.e., Medicare, Medicaid, Medicare Supplement, State Renal... ...and follows up with paperwork when claims are disputed for non-payment. Collects necessary documents...ClaimsWork at officeLocal area
$68.57k - $104.84k
...Clinical Review QC Auditor CERIS in Fort Worth, TX is seeking... ...regulations, including Medicare and Medicaid Understand and comply with... ...transparency in healthcare payments. We are a stable and growing... ..., Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A...Minimum wageFull timeWork at officeLocal areaRemote workFlexible hours$70.14k - $107.25k
...Clinical Review Auditor I The Diagnostic Related Groups (DRG)... ...regulations, including Medicare and Medicaid Understand and comply with... ...transparency in healthcare payments. We are a stable and growing... ..., Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A...Minimum wageFull timeWork at officeLocal areaFlexible hours- ..., seeks a Desk Adjuster to examine, evaluate, and resolve insurance claims while coordinating with various stakeholders. You will manage documentation, adhere to client timelines, and verify compliance with estimating guidelines. The ideal candidate has a Bachelor’s degree...Claims
- ...management of company-wide risk. Manages insurance procurement, develops and implements risk management and compliance policies/procedures, and manages claims and litigation. Manages relationships with third party service providers including brokers, underwriters,...Claims
- ...Responsiblefor ensuring Metrics are in compliance daily Responsiblefor... ...distribution of claims to designated staff to meet Client... ...and transparency in healthcare payments. We are a stable and growing... ...Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A...ClaimsMinimum wageFull timeWork at officeLocal areaFlexible hoursNight shift
$120k
...insurance organization seeking a Programs Auditor to join its growing Delegated Authority... ...strengthen controls, ensure regulatory compliance, and support continued growth. This role... ...authority programs, including underwriting, claims, premium accounting, and policy...ClaimsRemote work1 day per week- ...inspection documentation for accuracy and completeness. Verify compliance with client-specific requirements, templates, and service standards... ...operational support to the Scopemate Team Lead. Assist with claim assignment and dispatch activities during peak volume periods...Claims
- ...trade crypto using everyday payment methods like cards, Apple Pay... ...Australia—because trust and compliance are non-negotiable. But we’... ...every touchpoint, from initial integration to ongoing engagement, is... ...! If you receive an email - claiming to be from MoonPay - but from...ClaimsWork at officeRemote workWorldwideHome office
- ...5 p.m. Days Of Week: Monday through Friday Job Summary The Corporate Risk Manager directly supports the Corporate Risk Management, claims and insurance functions for the enterprise and assists in the overall operations of the Office of Legal Affairs. The role includes...ClaimsWork at officeMonday to Friday
$140k - $160k
...clients concerning business transactions, claim liabilities, advisability of prosecuting... ...High ethical standards and professional integrity. Ability to manage multiple projects and... ...by clicking the "Easy Apply" button. Compliance & Policies Jobot is an Equal Opportunity...ClaimsLocal area- ...capturing patient information to submitting claims and following up on reimbursements. Your... ...(EMRs); understanding of healthcare compliance regulations and reimbursement policies.... ...manner, meeting all regulatory deadlines. Payment Posting and Reconciliation Record and...Claims
- ...Senior Architect DLR Group is an integrated design firm with a promise to elevate the human... ..., the quality of project documents, claim prevention, team collaboration and communication... ...to practice standards, and protocol compliance Align design intent with project...ClaimsWork at office
- ...We take pride in serving our community with integrity, care, and real support. Whether we’re helping someone navigate a claim or personalize a plan, we believe in doing meaningful... ...toward established objectives. Maintain compliance with office and regulatory procedures....ClaimsFull timeWork at office
- ...#hybrid IREN is a vertically integrated AI Cloud provider, delivering... ...negotiation of variations, claims and dispute resolution outcomes... ...diligence, safety/insurance, compliance, master data, and onboarding... ...performance, including KPI monitoring, payment certification and incentive/...ClaimsFull timeContract workTemporary workFor contractors
- ...reviews to ensure quality, efficiency, and compliance with company guidelines and best... ...Foster a professional culture focused on integrity, collaboration, client service, and results... ...timely and effective communication with claims representatives, insureds, and company leadership...ClaimsFull time
$166k - $194k
...designed to meet the unique coverage and claims-handling needs of businesses. The Argo... ...ensuring alignment with program standards, compliance, and performance expectations. Champion... ...At Clearbrook our Core Values are Integrity, Collaboration, Pursuit of Excellence and...ClaimsFor contractorsLocal area- ...Futuristic Underwriters The Bodily Injury Claims Adjuster primary focus will be to... ...investigation, evaluation of all damages and payment of only what is owed to protect the interests... ...of Insurance Guidelines and remain in compliance, providing documentation through each...ClaimsFull timeContract work
- ...defined by the Leadership of Safety Administration and will ensure compliance with State and Federal regulations, as well as corporate,... ...reporting requirements Monitor and support all location insurance claims activities to ensure effective communication with claimants, to...ClaimsContract workWork at officeLocal area
- ...support organizational goals and ensure compliance with regulatory requirements. This role... ...program, including vendor partnerships, claims oversight, cost containment strategies,... ...opportunities to improve processes, systems integration, and employee experience. Conduct...ClaimsTemporary workLocal area
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