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... Required Qualifications Bachelor's degree in Healthcare or equivalent years of experience ... RN license 2 years of healthcare experience within a fraud investigations ... well as solid knowledge of..
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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 Senior Claims Process & Policy Professional processes ... modifications to existing policies, and claims forms. The Senior Claims Process & Policy Professional work ... variable factors. Responsibilities 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 ..
... (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..
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 ..
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..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Tampa Florida Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
Description The Senior Wellness Program Professional responsible for educating and motivating clients/employers to participate in the wellness program. The Senior Wellness Program Professional work assignments involve moderately complex to complex issues ..
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 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..
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 Associate Director for ACD Audit , at the director of the Director of Payment Integrity, will create and implement process improvement plans focused on the beneficiary and provider ..
Job Information Humana Senior Fraud & Waste Investigator - Remote in Tampa Florida Description Are you looking to be a part of a Fortune 100 company with competitive salary, opportunity for ..
