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Job Information Humana Medicaid Associate Director, Compliance Nursing in Salem Oregon Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
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 ..
Job Information Humana Manager, Fraud and Waste-Remote US in Salem Oregon Description The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste ..
Description The Senior Fraud and Waste Professional conducts investigations of allegations of fraudulent and abusive practices. The Senior Fraud and Waste Professional work assignments involve moderately complex to complex issues where ..
Description The Dental Fraud and Waste Investigator conducts investigations of allegations of fraudulent and abusive practices. The Dental Fraud and Waste Investigator work assignments are varied and frequently require interpretation and ..
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..
... degree Minimum 2 years of healthcare fraud investigations and/or claims auditing experience Knowledge of healthcare payment methodologies Strong clinical experience ... their home. We are a healthcare company committed..
... 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..
... Information Humana Inpatient Medical Coding Auditor (MSDRG/ APDRG)-Remote/Virtual in US in ... Oregon Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
Description Responsibilities The Compliance Professional 2 has responsibilities for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism Care Demonstration ..
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 ..
... Information Humana Outpatient Medical Coding Auditor-Remote/Virtual in US in Salem Oregon ... Oregon Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
... 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..
... 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 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..
Job Information Humana Pharmacy Desktop Auditor (Claims Professional 2) in Salem Oregon ... pharmacy claim review. The Pharmacy Claims Professional 2 work assignments are ... education and experience Prior pharmacy..
Job Information Humana Medical Coding Auditor - Outpatient & Surgical Specialty ... Oregon Description The Medical Coding Auditor reviews medical claims submitted against medical records provided, ... CPT, HCPCS). The..
... reducing waste and overuse of healthcare services, while encouraging high value ... Trend (CAT) team needs your healthcare, analytic, and research acumen to ... have the opportunity to support..
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 ..
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 ..
... strategic, data-driven initiatives to improve healthcare value in partnership with clinical ... by ensuring appropriate utilization of healthcare services while improving health outcomes ... by ensuring appropriate utilization of..
... Information Humana Inpatient Medical Coding Auditor-Remote/Virtual in US in Salem Oregon ... Oregon Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
