- Elevance Health (Columbus, OH)
- ** Audit & Reimbursement II ** **_Location:...auditor on S-10 audits. Assists higher level auditor on audit work and appeals as assigned + Perform ... for Medicare and Medicaid Services to transform federal health programs. The ** Audit and Reimbursement II ** , under guided supervision, will support audit… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Compliance Audit Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... required to achieve that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and… more
- LA Care Health Plan (Los Angeles, CA)
- Compliance Advisor II Job Category: Administrative, HR, Business Professionals Department: Compliance Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... safety net required to achieve that purpose. Job Summary The Compliance Advisor II ensures LA Care business units are compliant with all Product Lines' contractual,… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Quality Auditor II Job Category: Customer Service Department: Even MORE Quality Location: Los Angeles, CA, US, 90017 Position Type: Full ... Job Summary The Customer Solution Center Quality Auditor (QA) II is responsible for monitoring and actively influencing the...in the development of tools and procedures established to audit each vertical under the Customer Solution Center. In… more
- Medical Mutual of Ohio (OH)
- …outbound calls to members, providers, and pharmacies to initiate coverage determinations/ appeals , prescription refills, and switch members to lower cost therapeutic ... or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals , Grievances, and Medicare marketing material requirements. . Assists in… more
- Hackensack Meridian Health (Hackensack, NJ)
- …**I. Peer-to Peer (P2P) Concurrent appeals ** ** ii . Written Concurrent appeals ** **iii. Recovery Audit Contractors & levels of appeal** **iv. Root cause ... These include but are not limited to utilization review,** **hospital reimbursement , clinical compliance, case management, and transitions of care, as** **outlined… more
- Hackensack Meridian Health (Hackensack, NJ)
- …by: I. Peer-to Peer (P2P) Concurrent appeals ii . Written Concurrent appeals iii. Recovery Audit Contractors & levels of appeal iv. Root cause analysis ... UMC. These include but are not limited to utilization review, hospital reimbursement , clinical compliance, case management, and transitions of care, as outlined in… more
- Stanford Health Care (Palo Alto, CA)
- …possess the creativity and motivation to drive change, realizing maximized reimbursement and minimized financial risk to Stanford Health Care. Successful oversight ... activities of insurance claim editing and billing, insurance follow-up, denial and appeals + Serve as a contact/resource to other departments and clinics for… more