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... contract is responsible for processing claims for more than 6 million ... than 6 million members, the claims processing and financial management functions ... to an external vendor. The..
Description The Payment Integrity Professional 2 uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our ..
Description Responsibilities The SIU and PPI Lab review team is seeking a Medical Coding Auditor with a special set of skills. This person will focus on coding and clinical review of ..
Description The Medical Coding Auditor extracts clinical information from a ... coding guidelines. The Medical Coding Auditor work assignments are varied and ... guidelines/procedures. As a Medical Coding Auditor for..
... Risk Management Professional - Pharmacy claims in Cincinnati Ohio Description The ... the compliance of the pharmacy claims processing vendor relationship Develop executive-level ... job as we are a..
... looking for an experienced Senior Healthcare Investigator to join its industry ... Qualifications Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 3 years of..
Description The Senior Clinical Fraud and Waste Professional performs analysis of clinical investigations of allegations of fraudulent and abusive practices. The Senior Clinical Fraud and Waste Professional work assignments involve moderately ..
Description The Contract Administrator (Compliance Lead) ensures compliance with governmental requirements. The Compliance Lead works on problems of diverse scope and complexity ranging from moderate to substantial. Responsibilities The Contract Administrator ..
Job Information Humana Medical Coding Auditor - Outpatient & Surgical Specialty ... Ohio Description The Medical Coding Auditor reviews medical claims submitted against medical records provided, ... CPT, HCPCS). The..
... (ACD). The technician assists with claims review, provider record updates, and ... 30% Assist with submission of claims corrections and recoupments, while monitoring ... Qualifications 2 plus years of..
Job Information Humana Manager, Fraud and Waste-Remote US in Cincinnati Ohio Description The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste ..
... Information Humana Outpatient Medical Coding Auditor-Remote/Virtual in US in Cincinnati Ohio ... Ohio Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
Description The Nurse Auditor 2 will work on the ... lab audit concepts. The Nurse Auditor 2 will perform clinical audit ... waste, and abuse. The Nurse Auditor 2 work..
Description The Medical Coding Auditor reviews medical claims submitted against medical records provided, ... are met. The Medical Coding Auditor work assignments are varied and ... action. Responsibilities The Medical..
Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding Auditor work assignments are varied and ... for an experienced medical coding auditor to..
Description Humana's Claims Cost Management (CCM) organization is ... support our efforts for ensuring claims payment accuracy, so that our ... that our members receive quality healthcare at an affordable..
... Information Humana Inpatient Medical Coding Auditor (MSDRG/ APDRG)-Remote/Virtual in US in ... Ohio Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
... when they happen. The Nurse Auditor 2 validates and interprets medical ... of par and non-par provider claims to determine payment accuracy. Makes ... process improvements. Reviews and audits..
Description Humana's Provider Payment Integrity organization is looking for a Senior Vendor Management Professional to join the Data Mining Vendor Management team! As the Senior Vendor Management Professional you will act ..
Job Information Humana Pharmacy Desktop Auditor (Claims Professional 2) in Cincinnati Ohio ... pharmacy claim review. The Pharmacy Claims Professional 2 work assignments are ... education and experience Prior pharmacy..
... is looking for an experienced Healthcare Investigator to join its industry ... areas Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 1 year of..
... Information Humana Inpatient Medical Coding Auditor-Remote/Virtual in US in Cincinnati Ohio ... Ohio Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
Description Responsibilities The Utilization Management Nurse 2 will be responsible for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism ..
