Job Details. Description. The Payment Integrity Analyst is responsible for accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. This is a remote position. Essential Functions And Responsibilities. Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication. Abi...
Job Details. Description. The IT Compliance Analyst supports the organization’s compliance and risk management programs by coordinating assessments, audits, and certifications across frameworks such as HITRUST, SOC, HIPAA, and NIST. This role helps maintain a strong IT compliance posture by managing evidence, monitoring control performance, maintaining documentation, and partnering closely with IT, Security, Privacy, Legal and external auditors. ...
Job Details. Description. As an EDI Support Analyst with CERIS, you will provide technical support during and after implementation of healthcare electronic data interchange (EDI) solutions. These implementations will involve interaction with internal field offices as well as outside clients and third-party vendors. You will also conduct analysis of EDI transactions and are responsible for documentation and related reports. You will also be respon...
Job Details. Description. The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a UBIB submitted by a medical facility to determine accuracy of billed charges. This is a remote position. Essential Functions & Responsibilities. Collect supporting data and analyze information to make decisions regarding accuracy of billing. Appropriately document work and final conclusions in designated computer program. ...
Job Details. Description. The Hospital Bill Audit Nurse conducts hospital bill charge audits by reviewing medical records to verify that services were provided and charges are appropriate based on medical documentation and industry guidelines. The types of audits performed could include, but are not limited to inpatient, outpatient, NICU, and hospice. Charge audits identify overcharges, undercharges, and unbundled items per payor contract and ind...
