Auditor, Payment Integrity Specialist
4 weeks ago
We are seeking a skilled Auditor, Payment Integrity Specialist to join our team at Independence Blue Cross. As a key member of our organization, you will play a critical role in ensuring the accuracy of provider payments and charges.
The ideal candidate will have a strong background in healthcare provider audit methods and medical terminology, with the ability to analyze and investigate claims for fraud, waste, or abuse. Additionally, they will possess excellent analytical skills, interviewing and investigative skills, and working knowledge of MS Office, Excel, Word, Outlook, SharePoint, and Access.
As a Hybrid model employee, you will work in the office three days a week and remotely two days a week, with the flexibility to work from the Tri-State Area of Delaware, New Jersey, or Pennsylvania. We offer a dynamic and innovative work environment, with opportunities for professional growth and development.
Responsibilities include:
- Identifying patterns of provider billing for fraud, waste, or abuse
- Auditing claims to verify accuracy of provider payments and charges
- Analyzing and verifying provider billing, with a focus on desk reviews and medical billing records
- Addressing provider audit assignments to identify patterns of abuse or fraud
- Screening and auditing claims to select samples for audit, and initiating and verifying claim adjustments
- Identifying and referring potential provider fraud or abuse to management
- Providing work guidance to lower-level Provider Auditors
Qualifications include:
- Certified Pharmacy Technician (CPhT) required
- Four or more years of experience in healthcare provider audit, with two or more years of experience in healthcare claims or customer service
- Extensive knowledge of healthcare provider audit methods and medical terminology
- Demonstrated analytical skills, interviewing and investigative skills
- Working knowledge of MS Office, Excel, Word, Outlook, SharePoint, and Access
We are an Equal Opportunity and Affirmative Action Employer, and 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.
-
Auditor Payment Integrity Specialist
3 weeks ago
Philadelphia, Pennsylvania, United States Independence Blue Cross Full timeAuditor Payment Integrity RoleWe are seeking a skilled Auditor Payment Integrity to join our team at Independence Blue Cross. As an Auditor Payment Integrity, you will play a critical role in ensuring the accuracy of provider payments and charges.Responsibilities:Audit claims submitted to IBX to verify accuracy of provider payments and charges.Identify...
-
Commission Payment Specialist
4 weeks ago
Philadelphia, Pennsylvania, United States Beacon Hill Full timeCommission Payment SpecialistAt Beacon Hill, we are seeking a skilled Commission Payment Specialist to join our Commercial Team. The ideal candidate will have experience in calculating commission payments and ensuring compliance with company policies and sales plans.Key Responsibilities:Calculate commission payments for Commercial Team members using...
-
Night Auditor
3 weeks ago
Philadelphia, Pennsylvania, United States Concord Hospitality Full timeRole Summary: We are seeking a highly skilled Night Auditor to join our Front Office Team at the DoubleTree suites Philadelphia West. As a Night Auditor, you will be responsible for providing exceptional customer service, handling guest charges, and maintaining a high level of service and hospitality.Responsibilities:Assist guests efficiently, courteously,...
-
Senior Auditor
3 weeks ago
Philadelphia, Pennsylvania, United States Independence Blue Cross Full timeSenior Auditor Job DescriptionAt Independence Blue Cross, we are seeking a highly skilled Senior Auditor to join our team. As a Senior Auditor, you will play a critical role in identifying, examining, testing, and making recommendations concerning the internal controls, policies, and procedures of the Plan and its subsidiaries.Key Responsibilities:Plan,...
-
Payment Operations Specialist
2 weeks ago
Philadelphia, Pennsylvania, United States Motion Recruitment Full timeAs a Payment Operations Specialist at Motion Recruitment, you will be responsible for ensuring timely and accurate insurance claims processing.Key Responsibilities:Review and follow up on complex insurance claims to identify and collect outstanding balances.Meet production and quality requirements, providing excellent customer service to clients and...
-
Senior Auditor
4 weeks ago
Philadelphia, Pennsylvania, United States Independence Blue Cross Full timeAt Independence Blue Cross, we're seeking a highly skilled Senior Auditor to join our team. As a Senior Auditor, you will play a critical role in identifying, examining, testing, and making recommendations concerning the internal controls, policies, and procedures of our organization and its subsidiaries.The ideal candidate will have a strong background in...
-
Community Integration Specialist
4 weeks ago
Philadelphia, Pennsylvania, United States Community options Full time**Community Integration Specialist**We are seeking a skilled Community Integration Specialist to join our team at Community Options. As a Community Integration Specialist, you will be responsible for assisting individuals with learning physical, intellectual, emotional, and social life skills.The ideal candidate will have a strong background in supporting...
-
Workday Integration Specialist
4 weeks ago
Philadelphia, Pennsylvania, United States Syntricate Technologies Full timeJob Title: Workday Integration SpecialistJob Summary: We are seeking a highly skilled Workday Integration Specialist to join our team at Syntricate Technologies. The ideal candidate will have 6-8 years of experience in Workday Integration Cloud and Cloud Connect.Responsibilities:Design and implement Workday integration solutionsDevelop and maintain Cloud...
-
Philadelphia, Pennsylvania, United States Pennsylvania Medicine Full timePenn Medicine is a leading academic medical center dedicated to providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine.The Professional Fee Coding Data Integrity Specialist is responsible for validating data to further research and identify the root cause of data trends in coding...
-
Mulesoft Integration Specialist
4 weeks ago
Philadelphia, Pennsylvania, United States Diverse Lynx Full timeJob Title: Mulesoft Integration SpecialistJob Summary:We are seeking a highly skilled Mulesoft Integration Specialist to join our team at Diverse Lynx LLC. As a key member of our integration team, you will design and develop integration solutions using the Boomi platform to connect cloud and on-premise applications.Key Responsibilities:Design and develop...
-
Integration Specialist
4 weeks ago
Philadelphia, Pennsylvania, United States Temple Health Full timeJob SummaryTemple Health is seeking a skilled Integration Specialist to assist with the development and implementation of interfaces using an integration engine. The ideal candidate will work closely with the integration team to design, code, test, and document interfaces, ensuring seamless integration with hospital information systems.Key...
-
MuleSoft Integration Specialist
3 weeks ago
Philadelphia, Pennsylvania, United States Lorven Technologies Full timeJob Title: MuleSoft Integration SpecialistJob Summary:Lorven Technologies is seeking an experienced MuleSoft Integration Specialist to design, deploy, and administer MuleSoft AnyPoint platform on Cloud, Hybrid, RFTP, and Flex gateway. The ideal candidate will have 7+ years of experience in MuleSoft administration, Linux/Unix scripting, and API gateway...
-
Mulesoft Integration Specialist
3 weeks ago
Philadelphia, Pennsylvania, United States Diverse Lynx Full timeJob Title: Mulesoft Integration SpecialistJob Summary:We are seeking a highly skilled Mulesoft Integration Specialist to join our team at Diverse Lynx LLC. As a key member of our integration team, you will be responsible for designing and developing integration solutions using the Boomi platform to connect cloud and on-premise applications.Key...
-
Payments and Fraud Specialist
1 month ago
Philadelphia, Pennsylvania, United States Fliff Full timeJob Title: Payments and Fraud AnalystWe are seeking a skilled Payments and Fraud Analyst to join our team at Fliff, a pioneering social sports gaming company.Job Summary:The successful candidate will be responsible for ensuring the accuracy and efficiency of all payments, as well as detecting and preventing fraudulent activity.Key Responsibilities:Process...
-
Data Integration Specialist
1 month ago
Philadelphia, Pennsylvania, United States Brooksource Full timeCloud Data Solutions Lead6-Month Contract (Opportunity for Extension)RemoteBrooksource is seeking a Cloud Data Solutions Lead to manage the technical delivery of cloud-based data solutions. This individual will be responsible for overseeing the technical delivery of cloud-based data and integration solutions, with a strong focus on SQL/BigQuery, GCP, and...
-
Data Integration Specialist
4 weeks ago
Philadelphia, Pennsylvania, United States Children's Hospital of Philadelphia Full timeJob SummaryChildren's Hospital of Philadelphia (CHOP) is seeking a highly skilled Data Integration Specialist to join our team. As a Data Integration Specialist, you will be responsible for developing integrated biomedical data resources and associated applications that enable novel modes of data-intensive clinical and translational research.Key...
-
Night Auditor Position
4 weeks ago
Philadelphia, Pennsylvania, United States The Bellevue Hotel Full timeJob SummaryThe Night Auditor is a critical role at The Bellevue Hotel, responsible for ensuring the accuracy and integrity of all financial transactions. This position requires a detail-oriented individual with strong analytical skills and the ability to work effectively in a fast-paced environment.Key ResponsibilitiesReconcile all hotel cashier transactions...
-
Business Systems Integration Specialist
4 weeks ago
Philadelphia, Pennsylvania, United States Worldgate llc Full timeBusiness Systems Integration SpecialistWe are seeking a highly skilled Business Systems Integration Specialist to join our team at Worldgate LLC. As a key member of our enterprise IT systems team, you will play a critical role in supporting our clients' integration projects.Key Responsibilities:Conduct business analysis activities to support the integration...
-
Senior Financial Services Auditor
3 weeks ago
Philadelphia, Pennsylvania, United States Independence Blue Cross Full timeRenew and Reimagine the Future of HealthcareAt Independence Blue Cross, we are committed to enhancing the health and well-being of the people and communities we serve. As a Senior Financial Services Auditor, you will play a critical role in achieving our mission by identifying, examining, testing, and making recommendations concerning the internal controls,...
-
Anesthesiology Specialist
4 weeks ago
Philadelphia, Pennsylvania, United States Integrity Locums Full timeClinical DetailsOur client is seeking a skilled Anesthesiology Specialist to join their team. The ideal candidate will have experience in robotics, general and colorectal, gyne and urology, plastics, and ortho cases. The successful candidate will work under medical supervision and be responsible for providing high-quality patient care.RequirementsThe...