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Holy Name Hospital

Hackensack, New Jersey

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Kindred Hospitals

La Mirada, California

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Kindred Hospitals

Lima, Ohio

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Kindred Hospitals

Las Vegas, Nevada

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UCLA

Los Angeles, California

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BJC HealthCare

Saint Louis, Missouri

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Optum

Wichita, Kansas

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Cook County Health & Hospital System

Chicago, Illinois

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UNC Health

Chapel Hill, North Carolina

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Beebe Healthcare

Lewes, Delaware

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ScionHealth

Muskogee, Oklahoma

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Optum

Indianapolis, Indiana

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Kindred Hospitals

Riviera Beach, Florida

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Optum

Minnetonka, Minnesota

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Kindred Hospitals

Rancho Cucamonga, California

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Duke University Health System

Durham, North Carolina

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WakeMed Health & Hospitals

Raleigh, North Carolina

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Kindred Hospitals

Ontario, California

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CHRISTUS Health

Corpus Christi, Texas

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Fred Hutchinson Cancer Center

Seattle, Washington

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CHRISTUS Health

Corpus Christi, Texas

University of South Carolina Upstate

Spartanburg, South Carolina

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Nicklaus Children’s Health System

Miami, Florida

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Claims Quality Review Auditor - Healthcare
JOB SUMMARYThe Claims Quality Review Auditor is HYBRID position accountable for auditing various claims to ensure quality and accuracy to related benefit payments, contract interpretation, and compliance with policies and procedures and regulatory guidelines. Makes recommendations to improve quality, workflow processes, policies and procedures.ESSENTIAL FUNCTIONS OF THE ROLETracks and trends audits in an effort to identify root cause errors to providers; provides feedback.Ensures that the department's procedural manuals consistently help adherence to regulatory guidelines, internal policies and procedures related to claims processing and departmental accuracy standards related to claims payment.Develops practi


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