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Management Recruiters of Raleigh
, PA, United States
We have an excellent opportunity in Northwestern PA for an Integrity Engineer! About the Opportunity : Our client, an Independent Petroleum Company with operations in the northern US & Canada, has an excellent opportunity in its Warren, PA headquarters for a Pipeline Integrity Engineer. About the Position: This is an exciting opportunity to
Job Source: Management Recruiters of RaleighAccuity
Philadelphia, PA, United States
Job Type Full-time Description POSITION SUMMARY: As a valued member of the DRG Review Team, the DRG Integrity Specialist performs a secondary level review of medical records and code assignment using knowledge of Accuity technology and client systems with a physician in accordance with federal coding regulations and guidelines as well as client s
Job Source: AccuityAccuity
Philadelphia, PA, United States
Job Type Full-time Description POSITION SUMMARY: As a valued member of the DRG Review Team, the DRG Integrity Specialist performs a secondary level review of medical records and code assignment using knowledge of Accuity technology and client systems with a physician in accordance with federal coding regulations and guidelines as well as client s
Job Source: AccuityAlpine Solutions Group
Camden, NJ, United States
DAY TO DAY: Our healthcare client is seeking a Revenue Integrity Specialist to join their emerging team as a full-time hybrid employee. In this role, you will focus on issues that come up reactively day to day concerning hospital and professional billing, ensuring charges are processed accurately, reporting on trends, and working across various dep
Job Source: Alpine Solutions GroupTemple University
Philadelphia, PA, United States
Grade: T28 The link below will give you information about the University's "T" salary structure. Learn more about the "T" salary structure . A variety of important factors are reviewed by HR when considering salary, including job duties, the applicant's education and experience, all relevant internal equity considerations, department budget, an
Job Source: Temple UniversityAccuity
Mount Laurel Township, NJ, United States
Job Type Full-time Description POSITION SUMMARY: As a valued member of the DRG Review Team, the DRG Integrity Specialist performs a secondary level review of medical records and code assignment using knowledge of Accuity technology and client systems with a physician in accordance with federal coding regulations and guidelines as well as client s
Job Source: AccuityCONTACT GOVERNMENT SERVICES
Philadelphia, PA, United States
Auditor Employment Type: Full-Time, Mid-Level Department: Financial CGS is seeking a highly skilled Auditor to provide general auditing and accounting services in support of fraud investigations involving potentially complex financial transactions and complex organizations attempting to evade detection. The ideal candidate will develop, coordinate,
Job Source: CONTACT GOVERNMENT SERVICESJobot
Fort Washington, PA, United States
A well known IT audit services company in the Philly area is expanding its team. They have a great collaborative culture and established clientele around the country. Great benefits as well! This Jobot Job is hosted by: Alex Dickinson Are you a fit? Easy Apply now by clicking the "Apply Now" button and sending us your resume. Salary: $75,000 - $10
Job Source: JobotPhiladelphia, PA, United States
Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.
The Auditor Payment Integrity audits claims submitted to IBX to verify accuracy of provider payments and charges.
Responsibilities includes:
* Identify patterns of provider billing for fraud, waste, or abuse.
* Audits encompass identification of inappropriate billing through daily reviews, live audits, and desk audits.
* This function also includes analysis, verification and adjustment of provider billing based primarily on desk reviews or provider medical billing records in close conjunction with CFID audit analysis, auditors, and investigators.
* Address the usual and customary Provider Audit assignments to identify patterns of provider abuse or fraud in accordance with sound audit methods and practices.
* Screen and audit samples in summary and in detail to select claims for audit. Initiate and verify claim adjustments, maintain audit documentation, and prepare statistical data.
* Identify and refer potential provider fraud or abuse to management. Identify and participate in development and implementation of new audit functions.
* Provide work guidance to lower-level Provider Auditors.
QUALIFICATIONS:
* Provide work guidance to lower-level Provider Auditors.
* Certified Pharmacy Technician (CPhT) required.
* Certified Pharmacy Tech for Pharmacy Audit.
* Four (4) or more years' experience which includes two (2) or more of health care Provider Audit experience and may include two (2) or more years of health care Claims or Customer Service experience.
* Extensive Knowledge of health care provider audit methods and medical terminology. Demonstrated analytical skills, interviewing and investigative skills.
* Working Knowledge of MS Office, Excel, Word, Outlook, SharePoint, Outlook, Access, etc.
Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania
Equal Employment Opportunity
Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
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Email Alert for Auditor, Payment Integrity (Pharmacy) jobs in Philadelphia, PA, United States
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