Clinical Auditor

Job Title: Clinical AuditorAt Zelis, we are seeking a highly skilled Clinical Auditor to join our team. As a Clinical Auditor, you will be responsible for conducting in-depth reviews of medical claims to ensure compliance with accepted medical guidelines and clinical criteria.Key Responsibilities:Conduct thorough reviews of medical claims to identify...

Job Title: Clinical AuditorZelis is seeking a skilled Clinical Auditor to join our team. As a Clinical Auditor, you will be responsible for conducting thorough reviews of healthcare claims to ensure compliance with medical guidelines and regulations.Key Responsibilities:Conduct in-depth reviews of healthcare claims to identify potential errors or...

Job Title: Clinical AuditorZelis is seeking a skilled Clinical Auditor to join our team. As a Clinical Auditor, you will be responsible for conducting thorough reviews of healthcare claims to ensure compliance with medical guidelines and regulations.Key Responsibilities:Conduct in-depth reviews of healthcare claims to identify potential errors or...

Job SummaryZelis is seeking a skilled Clinical Auditor to join our team. As a Clinical Auditor, you will be responsible for conducting in-depth claim reviews to ensure compliance with medical guidelines and billing rules.Key ResponsibilitiesConduct post-service, pre or post payment claim reviews based on accepted medical guidelines and clinical...

Job SummaryEmory University is seeking a highly skilled Clinical Trials Auditor to join our team. As a Clinical Trials Auditor, you will be responsible for ensuring compliance with federal and state laws and regulations, as well as the University's policies and procedures related to clinical trials.Key ResponsibilitiesConduct audits to ensure compliance with...

Job SummaryZelis is seeking a skilled Clinical Auditor to join our team. As a key member of our team, you will be responsible for conducting in-depth claim reviews to identify revenue opportunities and optimize payment integrity.Key ResponsibilitiesConduct post-service, pre or post payment claim reviews based on accepted medical guidelines and clinical...

Job SummaryZelis is seeking a highly skilled Clinical Auditor to join our team. As a key member of our organization, you will be responsible for conducting thorough reviews of healthcare claims to ensure compliance with medical guidelines and billing rules.Key ResponsibilitiesConduct in-depth reviews of facility and outpatient bills to ensure accuracy and...

Job OverviewMMS is a leading clinical research organization (CRO) that prides itself on being a Great Place to Work certified organization, recognized for its exceptional culture and industry-best employee retention rate.We are seeking a highly skilled GCP Auditor to join our team. As a GCP Auditor, you will be responsible for conducting vendor qualification...

Hospital Bill Auditor Job DescriptionWe are seeking a highly skilled Registered Nurse to join our revenue integrity team as a Hospital Bill Auditor. This is a full-time permanent opportunity that offers growth opportunities and a chance to work with a managed care company.Key Responsibilities:Conduct audits of hospital bills to ensure accuracy and compliance...

Job Title: Nurse ReviewerJob Summary:Zelis is seeking a highly skilled Nurse Reviewer to join our team. As a Nurse Reviewer, you will be responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment...

Job SummaryThe Nurse Reviewer will be responsible for conducting in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments. This role requires a strong understanding of audit techniques, identification of revenue opportunities, and financial negotiation...

Job SummaryThe Nurse Reviewer will be responsible for conducting thorough reviews of medical claims to ensure compliance with regulatory guidelines and company policies. This role requires a strong understanding of healthcare regulations, medical coding, and billing practices. The ideal candidate will have experience in auditing and claims review, with a...

Job SummaryWe are seeking an experienced Accounting Manager to join our team at Experity Defunct. The successful candidate will be responsible for overseeing multiple functions within the Accounting Department, including Financial Statement Preparation, Financial Reporting, Technical Accounting Research, Treasury, and/or Other General Accounting...

Job SummaryWe are seeking a highly skilled Research Compliance Specialist to join our team at Children's Healthcare of Atlanta. In this role, you will be responsible for ensuring compliance with federal and state regulations and guidelines related to pediatric clinical research.Key ResponsibilitiesDevelop and implement research policies and procedures in...

Aegis Therapies is seeking a skilled Director of Rehabilitation to lead our therapy department. As a key member of our team, you will be responsible for inspiring and guiding your team to deliver exceptional patient care. With a strong focus on career growth and development, we offer ongoing training, advancement opportunities, and clinical support to help...

About Experity:Experity is a premier software and services provider in the on-demand healthcare sector within the U.S. Our innovative software solutions streamline operations for over 5,700 urgent care clinics nationwide, enhancing the entire patient experience—from appointment scheduling to billing. Our mission is to transform healthcare by delivering...

Job Title: Comptroller/Director of FinanceAltesa Biosciences Inc is seeking a highly skilled Comptroller/Director of Finance to join our team.This is a remote job opportunity for a candidate in the metro-Atlanta or DC area.The successful candidate will be responsible for:Providing financial guidance to the CEO and executive team for strategic planning...

Job SummaryWe are seeking a highly skilled Government Reimbursement Manager to join our team at Emory Healthcare. As a key member of our finance department, you will be responsible for overseeing the financial reporting and analysis related to governmental reimbursements, including cost reporting and audits.Key ResponsibilitiesEnsure accurate and timely...

Clinical Provider Auditor II Supports the Payment Integrity line of business Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights,...

Hospital Bill AuditorThis is a full-time permanent opportunity for a managed care company, which allows a nurse leader for more growth opportunities. We are looking for highly skilled, self-motivated, registered nurses (RN) who can provide support to the revenue integrity team. This nurse will complete audits following department guidelines and the...

Hospital Bill Auditor This is a full-time permanent opportunity for a managed care company, which allows a nurse leader for more growth opportunities. We are looking for highly skilled, self-motivated, registered nurses (RN) who can provide support to the revenue integrity team. This nurse will complete audits following department guidelines and the partners...

Hospital Bill AuditorThis is a full-time permanent opportunity for a managed care company, which allows a nurse leader for more growth opportunities. We are looking for highly skilled, self-motivated, registered nurses (RN) who can provide support to the revenue integrity team. This nurse will complete audits following department guidelines and the...

Job DescriptionJob DescriptionDescription:Core Clinical Partners stands at the forefront of Emergency and Hospital Medicine, delivering unparalleled services through a model that emphasizes patient-centric care and operational excellence. Our corporate values – Genuine, Accountable, Dynamic, Respectful, and Fun – are the pillars that uphold our...

Job DescriptionJob DescriptionIN SUMMARY...The Regulatory Project Manager main function is to ensure that Azalea products empower hospitals and clinics to qualify for, fully participate in, and receive maximum reimbursements from all relevant regulatory programs. The role works closely with all teams in prioritizing, designing, testing, and completing...

Experity is the leading software and services company for on-demand healthcare in the U.S. We provide software solutions that remove complexities and simplify operations for 5700+ urgent care clinics across the country. We create, maintain, and support products to facilitate the complete on-demand healthcare experience: from patients finding clinics and...

Experity is the leading software and services company for on-demand healthcare in the U.S. We provide software solutions that remove complexities and simplify operations for 5700+ urgent care clinics across the country. We create, maintain, and support products to facilitate the complete on-demand healthcare experience: from patients finding clinics and...

Job DescriptionJob DescriptionSalary Range$80k to $120,000 annually.LocationHybrid – Atlanta, GAPrimary ResponsibilitiesActively researches and develops interventions that can be used to improve performance and clinical quality and support HEDIS, clinical measures and the accreditation process.Identifies, leads and facilitates performance improvement...

Job DescriptionJob DescriptionSalary Range$80k to $120,000 annually.LocationHybrid – Atlanta, GAPrimary ResponsibilitiesActively researches and develops interventions that can be used to improve performance and clinical quality and support HEDIS, clinical measures and the accreditation process.Identifies, leads and facilitates performance improvement...

Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs). Work Shift Day Work Day(s) Friday, Monday, Thursday, Tuesday, Wednesday Shift Start Time 9:00 AM Shift End Time 5:00 PM Worker Sub-Type Regular Children's is one of the nation's...

Job SummaryEmory Healthcare is seeking a highly skilled Senior Financial Analyst to join our team in the Net Patient Service Revenue (NPSR) department. As a key member of our finance team, you will be responsible for overseeing the financial reporting related to patient service revenue, ensuring accurate and timely revenue recognition, and calculating the...

Supports the Carelon Payment Integrity line of businessLocation: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles from our Elevance Health Pulse Point locations.Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is...

Location: The ideal candidate will live within 50 miles of one of our pulse point locations and will work on a hybrid work model (1-2 days per week in the office).Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate, and prevent unnecessary...

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