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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 Director of Health Services for National Medicaid Clinical Operations utilizes clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Director, Health ..
Description The Nurse Auditor 2 performs clinical audit/validation processes ... support optimal reimbursement. The Nurse Auditor 2 work assignments are varied ... when they happen. The Nurse Auditor 2 validates..
Description The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an ..
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 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 ..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Phoenix Arizona Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
... 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 ... Arizona Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
... 5 or more years of healthcare revenue cycle management experience may ... for Medicare and Medicaid related claims) Experience with Auditing and monitoring ... with Auditing and monitoring of..
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..
... 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..
OverviewThe primary purpose of the position is the management and administration of all aspects of rehabilitation services for the respective communities as well as for maintaining a clinical caseload.The Rehabilitation Program ..
... Information Humana Inpatient Medical Coding Auditor-Remote/Virtual in US in Phoenix Arizona ... Arizona Description The Medical Coding Auditor extracts clinical information from a ... patient records. The Medical Coding..
Job Information Humana Medical Coding Auditor - Outpatient & Surgical Specialty ... Arizona Description The Medical Coding Auditor reviews medical claims submitted against medical records provided, ... CPT, HCPCS). The..
Job Information Humana Manager, Fraud and Waste-Remote US in Phoenix Arizona 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 Phoenix Arizona ... Arizona 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 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 ..
... mind and spirit. The Pharmacy Claims Reviewer is responsible for reviewing ... is responsible for reviewing pharmacy claims submitted through the CVS Health ... submitted through the CVS Health..
