Strategic Healthcare Claims & Vendor Auditor
Johns Hopkins Health Plans
Johns Hopkins Health Plans is seeking a Vendor Auditor to independently conduct claims and vendor performance audits, ensuring compliance with contracts, regulations, and quality standards. The role oversees high‑risk vendors, evaluates claims accuracy, and monitors remediation, producing reports and scorecards for leadership review. The ideal candidate will have advanced knowledge of claims adjudication, Medicare/Medicaid reimbursement, and healthcare policies, with strong analytical and #J-18808-Ljbffr Johns Hopkins Health Plans
- ...Hopkins Health Plans, Hanover, MD 21076 Category:Healthcare Operations Schedule:Day Shift Employment Type:... ...general supervision of the Department Director, the Vendor Auditor is responsible for independently conducting claims and vendor performance audits to ensure...ClaimsFull timeLocal areaDay shift
- ...interpretation of medical records and claim documentation to assist with... ..., or other qualified healthcare provider. Other skills... ...relationships with clients, vendors and/or any other representatives... ...; Works quickly. Strategic Thinking - Develops strategies...Claims
$71.1k - $97.8k
...community The Inpatient Medical Coding Auditor extracts clinical information from a... ...coding auditor to review inpatient hospital claims for proper reimbursement, handle... ...to encourage personal wellness and smart healthcare decisions for you and your family while...ClaimsBi-weekly payFull timeContract workTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday- ...about an exciting opportunity to join our team. Impact You'll Make Contribute to complex healthcare consulting engagements involving coding and billing audits, disputes, claims analysis, investigations, compliance reviews, and litigation support. Deliver accurate,...ClaimsContract workFlexible hours
- ...Responsibilities As our Auditor Coder Specialist you will be... ...fraud and ensure adherence to healthcare laws directly supporting sound... ...corrects or appeals denied claims as assigned; recommends Epic... ...evolved over the years through strategic partnerships and integrations...ClaimsFull timeWork experience placement
$30.7 - $41.54 per hour
..., hands-on experience processing medical claims? Do you enjoy applying your claims expertise... ...be the ideal candidate for our Claims Auditor position within our Health & Welfare group... ...with other auditors, outside vendors, account executives, department supervisors...ClaimsHourly payFull timeWork at officeLocal area3 days per week- ..., specialty, and rebates for PBM contracts. The role requires collaborating with sales and account services on pricing strategy, utilizing advanced Excel to analyze large pharmacy claims datasets, and presenting analyses to executives during #J-18808-Ljbffr CVS HealthClaims
- ...Government Relations Consulting Healthcare Savings & Investing Finance Brokerage... ...~ ancillary benefit management ~ claims management ~ provider network ~ pharmacy... ...Strategy to set and execute the strategic direction for its liability claims operations...Claims
- Senior Strategic Communications Advisor (Fixed Term Contractor) Department: Client Engagement... ...the Behavioral Intelligence layer for healthcare — revealing why people behave as they do... ..., including flagging unsupported claims, working from named data sources and statistics...ClaimsFull timeContract workTemporary workPart timeFor contractorsFixed term contractRemote work
$56.36k - $62k
...positions which contribute to the overall strategic success of Howard University. Hiring... ...documentation review, conducts assigned claim follow-up and rebilling, supports treatment... ...Data Management, insurers, and outside healthcare partners. The PCC II manages assigned insurance...ClaimsTemporary workWork at officeFlexible hours$65k - $80k
...period review. COMPANY OVERVIEW: Healthcare Legal Solutions, LLC is a fast-growinghealthcare... ...for settling a high volume of claims using creative, innovative, and flexible... ...even when dealing with emotional topics Strategic Thinking - Develops strategies to achieve...ClaimsWork at officeFlexible hours$50k - $55k
...To $55,000.00 Annually Company Overview Healthcare Legal Solutions, LLC is a fast-growing healthcare... ...technology used to process insurance claims and supporting documents. The IT... ...market and competition; Aligns work with strategic goals. Business Necessity- The needs of...Claims- ...HoloLens). Our specialization is in healthcare, however we support clients... ...and Development, to help strategize for and educate potential... ...Verification, Charge Capture, Coding, Claim Submission, Remittance... ...projects. Prior involvement in vendor-side sales support or client-...ClaimsFull timeWork at office
$115.02k - $207.22k
...identifying coding discrepancies and recoverable claim opportunities, and supporting regulatory... ...you will make an impact: •Sets the strategic direction for audit methodologies,... ...improving lives and communities - and making healthcare simpler. We are a Fortune 25 company...ClaimsFull timeTemporary workWork experience placementWork at officeLocal areaShift work3 days per week1 day per week- ...accurate billing, denial management, and timely client communication. As part of our Billing Team, you will handle insurance coordination, claim submissions, eligibility checks, and payment reconciliations while ensuring a high level of service and compliance with payer...ClaimsMonday to Friday
$176.9k - $239.34k
...Qualifications: Bachelor's degree in business, healthcare, or a related field. Five years of... ..., appeals/denials, coding, billing, claims, benefit design, and patient support... ...based reimbursement organization. Proven strategic planning, analytical reasoning, and fact...ClaimsFull timeWork at officeLocal areaRemote workWork from homeFlexible hours- ...compensation accounts in Washington this position you will be the lead auditor and financial examiner in charge of independently planning... ...elect to administer and pay their own workers compensation claims. Here is what we are looking for: Demonstrated critical thinking...ClaimsPermanent employmentFull timeWork experience placementWork at officeFlexible hours
$63k - $70k
...which contribute to the overall strategic success of Howard University.... ...Perform billing, coding, claims submission, denials, AR, and... ...utilization Maintain compliance with healthcare regulations such as HIPAA,... ...main point of contact for vendors, billing services, and...ClaimsWork at officeFlexible hours- Healthcare Legal Solutions, LLC is seeking an IT Specialist to support a high-volume automated appeals operation. You will monitor, troubleshoot, and optimize technology used to process insurance claims and supporting documents, ensuring seamless data flow between client...Claims
$65k - $88.6k
...Audit team and guide the achievement of Humana's strategic and financial objectives as an Internal Auditor. Reporting to the Internal Audit Manager, you will... ...designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing...Full timeTemporary workApprenticeshipWork at office- ...operator of hospitals, nursing centers & other healthcare facilities Industry Hospital &... .... The role also oversees liability claims, settlement recommendations, legal reserves... ...is required. The role calls for strong strategic judgment, experience managing outside counsel...Claims
- ...of Sales About the Company AI-enabled healthcare revenue cycle management company serving complex medical billing and claims recovery. Industry Hospital & Health... ...team but also personally handling the most strategic deals. The ideal candidate for the Vice President...Claims
$75k - $90k
...Healthcare Actuarial Senior AnalystClient-facing health benefits consulting. Closer to multi... ...the work spans employer programs, vendors, and client deliverables across a region... ...pricing, plan design, reserve calculations, claim reporting, and financial modeling while...ClaimsWork at officeVisa sponsorship- ...Sciences About the Company AI-driven healthcare analytics platform Industry... ...real world evidence lab data and claims data Business Classifications SAAS... ...approach. The ideal candidate will be a strategic thinker, with the ability to align client...Claims
$35 - $40 per hour
Industry: Nonprofit / Healthcare / Professional Association Location (city... ...responsibilities with strategic thinking, using data and technology... ...carriers, brokers, and external vendors to address enrollment, billing, eligibility, and claims concerns. Assist with annual...ClaimsHourly payLong term contractPermanent employmentContract workTemporary workWork at officeLocal areaMonday to FridayFlexible hours2 days per week3 days per week$55k - $75k
...company perks...Small company feel! In this role, the Medicaid Auditor will be responsible for performing and reporting on Medicaid... ...guidelines for coverage determinations. Experience in reviewing claims for appropriate billing and medical coding requirements, performing...ClaimsRemote jobFull timeContract workTemporary workFor contractorsWork at officeLocal areaFlexible hours- ...Description Healthcare Legal Solutions is seeking an experienced Senior Coding Specialist... ...support our end - to - end appeals and claims recovery operations. This role will be... ...appealed claims is accurate, compliant, and strategically aligned with payer requirements and...Claims
$115k - $130k
...Fortune Best Workplaces in Financial Services & Insurance Claims Advisor, Professional Liability | E&O, D&O ARE YOU AN IDEAL... ...guidelines. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients....ClaimsFull timeWork at officeLocal areaFlexible hours$80k - $90k
...necessary to support its programs, staff, and strategic priorities. Working closely with the... ...processes and maintain accurate vendor and financial records, including W-9 documentation... ...Coordinate workers’ compensation claims and maintain incident reports Respond...ClaimsFull timeWork at office$23 - $25 per hour
...Follow-Up Representative Location: Bethesda, MD Industry: Healthcare Revenue Cycle / Accounts Receivable Pay: $23$25 per hour (... ...system. To support the clean-up and resolution of these outstanding claims, the organization is seeking experienced AR Follow-Up...ClaimsHourly payContract workCasual workWork at officeLocal areaFlexible hours
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