12 quality audit representative jobs found

Job DescriptionThe Enrollment Representative position will be supporting multiple health plans. Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates transfer of non-electronic eligibility data. Responds, researches, and resolves eligibility and/or billing related issues involving member specific information;Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.() Monitors daily status reports assessing output for developing trends potentially impacting service levels. () Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters. () Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the...

Additional Location(s): US-MN-Maple Grove; US-CA-Valencia; US-GA-Alpharetta; US-IN-Spencer; US-MA-Marlborough; US-MN-Arden Hills Diversity - Innovation - Caring - Global Collaboration - Winning Spirit - High Performance At Boston Scientific, we'll give you the opportunity to harness all that's within you by working in teams of diverse and high-performing employees, tackling some of the most important health industry challenges. With access to the latest tools, information and training, we'll help you in advancing your skills and career. Here, you'll be supported in progressing - whatever your ambitions. About the role: Develops, establishes and maintains quality engineering methodologies, systems, and practices which meet BSC, customer, and regulatory requirements. Serves as a Global Design Controls Quality representative to improve awareness, visibility, and communication on global initiatives to support departmental, functional, site, divisional and corporate quality...

Current Employees: If you are a current employee at Ryder (not a Contractor or temporary employee through a staffing agency), please click here (http://wd5.myworkday.com/ryder/d/task/1422$3.htmld) to log in to Workday to apply using the internal application process. Job Seekers can review the Job Applicant Privacy Policy by clicking HERE. (https://ryder.com/job-applicant-privacy-policy) You are the driving force behind our company. Start your career with Ryder today! Summary MOVE YOUR CAREER FORWARD WITH RYDER! Be a vital player for one of the largest and most recognizable names in Logistics, Transportation, Fleet Maintenance and Supply Chain Services in the World! The Lead Continuous Improvement Engineer (individual contributor) supports the development of the Ryder Continuous Improvement culture across the Business Unit/Vertical by actively promoting and facilitating the use of...

**You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.****Optum** is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start **Caring. Connecting. Growing together.**The **Provider Installation Representative** is responsible for various activities related to the Provider Network database which may include: database maintenance, reporting and extracting data for various reports and analyses, and initiating database improvement. The Provider...

Regence (FEP) Customer Service Professional I Fulltime Remote in WA, ID, OR and UT. Candidates outside of these states will not be considered. Starting pay range $16.20 - $20.10 DOE and Location. HR will reach out and provide specific information. Call Center hours are Monday - Friday, 7am - 7pm PDT Start date: Monday, May 15th, 2023 IMPORTANT: We will be conducting verification of employment on your current and past employment if selected to hire. Please make sure you are applying with the most updated resume with correct dates of employment. Primary Job Purpose: Due to growth of our company and department, we are looking to expand our team. Bring your excellent customer service skills to the FEP (Federal Employee Program) Customer Service role! As an FEP Customer Service Professional, you will inform, educate, and assist members, providers, other health-care professionals, or other provider representatives on recorded phone lines regarding...

It's fun to work in a company where people truly BELIEVE in what they're doing! We're committed to bringing passion and customer focus to the business. The Payroll Representative assists with the preparation of a bi-weekly payroll, payroll related summaries, surveys, reports, including the reporting and filing of the quarterly and year-end taxes. this is a remote position but must live local to our office. Qualifications: Bachelor's degree or an equivalent combination of experience and education Minimum of one (1) years of payroll experience Working knowledge of Federal and State payroll tax regulations and reporting Knowledge of general payroll practices, including wage and hour regulations Basic skill level in using Microsoft Office Products (Excel, Word, PowerPoint and Outlook) and integrated Payroll/HRIS systems Good written and verbal communication skills; organized and detail oriented Competencies: Satisfactorily complete competency requirements for this...

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) As an Associate Accounting Director within our Regulatory Finance - Accounting and Reporting division you will be responsible for providing in-depth financial reporting oversight and analysis for six to eight regulated entities and implementing best practices as it relates to the reporting process. You will review and synthesize financial data pursuant to Statutory Accounting Principles (SAP), which is based on Generally Accepted Accounting Principles (GAAP), for presentation to senior management and submission to external constituencies. You will be responsible for overseeing the completion of annual audits for assigned regulated entities...

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. Job Type: Regular Scheduled Hours: 40 Work Shift: Day (United States of America) Under the direction of the Hospital Coding Manager or Supervisor, and exercising independent judgment within the scope of the job, the Hospital Inpatient Coder II assigns applicable ICD-10 Codes, Present on Admission (POA), Hospital Acquired Condition (HAC), and Patient Safety Indicators (PSI) using current industry standards, the Official Coding Guidelines, Coding Clinic, UHDDS and regulatory requirements. Ensures the integrity and quality of patient data to achieve minimal variation in coding practices; assigns codes only as supported by physician/licensed independent practitioner (LIP) documentation within the body of the medical record. Applies in-depth knowledge of medical terminology and anatomy and physiology specific to coding. This is a remote position. Job Description:...

Job DescriptionMeritain Health's Call Center has multiple openings for Customer Service Representatives to support our Amherst, NY office. This is a work from home position in the state of NY.-This position handles customer service inquiries and problems via telephone, internet or written correspondence. -Customer inquiries are of basic and routine nature.-Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors.-Triages resulting rework to appropriate staff. -Documents and tracks contacts with members, providers and plan sponsors. -The CSR guides the member through their members plan of benefits, Aetna policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines. -Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members' best health. -Taking accountability to fully understand the member's needs by building a...

Job Locations US-VA-Smithfield Your Opportunity The Senior Operations Finance Analyst role is responsible for partnering with several areas of the business to foster advanced understanding of critical financial and operational processes as well as the information generated by these transactions. The Senior Analyst, in partnership with Ops Finance Analytics team, will be responsible for designing and maintaining financial models that will optimize and add value to company operations. This role will leverage analytical methodologies to deliver value in providing analytics subject matter expertise, creative problem-solving, and strategic planning. The Sr. Analyst role is also responsible for the monitoring and analysis of company capital spending, including assets, operational equipment, machinery and more. The role will partner with several company functions to provide essential insights as to the planning, budgeting, and success of capital projects. This role will also drive...

Job Locations US-VA-Smithfield Your Opportunity The Senior Operations Finance Analyst role is responsible for partnering with several areas of the business to foster advanced understanding of critical financial and operational processes as well as the information generated by these transactions. The Senior Analyst, in partnership with Ops Finance Analytics team, will be responsible for designing and maintaining financial models that will optimize and add value to company operations. This role will leverage analytical methodologies to deliver value in providing analytics subject matter expertise, creative problem-solving, and strategic planning. The Sr. Analyst role is also responsible for the monitoring and analysis of company capital spending, including assets, operational equipment, machinery and more. The role will partner with several company functions to provide essential insights as to the planning, budgeting, and success of capital projects. This role will also drive internal...

Description Play a vital role in the delivery of world-class patient care. Take your career in an exciting new direction. At UCLA Health, you can do all this and more. The Patient Communication Center (PCC) Access Supervisor oversees and coordinates the day-to-day operations of the Patient Communication Representatives and services. You will supervise all inbound and outbound calls with consumers, patients, physicians, and others to ensure quality, productivity, and service expectations are met. In this role you will cultivate and maintain strong working relationships with internal and external customers (i.e. employees, physicians, clinical site managers, directors, etc.). Your duties will include but not be limited to: * Monitor/ Oversee all appointment scheduling and registration activities for supported sites; ensure that clinics are scheduled according to protocol and that clinic schedules are accessible according to Health System standard * Assist with calls to ensure...