- Elevance Health (Columbus, OH)
- ** Audit & Reimbursement II - Medicare Cost Report Audit ** **Locations:** _This is a United States based, virtual position._ **National Government ... Medicaid Services to transform federal health programs The Audit and Reimbursement II will support our Medicare Administrative Contract (MAC) with the… 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, 90017 ... that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for...(DHCS), Department of Public Social Services (DPSS), Centers for Medicare and Medicaid Services(CMS), LACC - CalHers, and National… more
- Medical Mutual of Ohio (OH)
- …(medical drug) programs as needed. . Performs other duties as assigned. ** Medicare Pharmacy Coordinator II ** Working under general supervision, administers ... mail pharmacy. . Intermediate Microsoft Office skills (Excel, Word, Power Point). ** Medicare Pharmacy Coordinator II ** . Associate Degree in Business… more
- Ventura County (Ventura, CA)
- …is responsible for billing and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare , and general ... Medical Billing Specialist I/ II Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4658466) Apply Medical Billing Specialist I/ II Salary… more
- Ventura County (Ventura, CA)
- Behavioral Health Finance Analyst I/ II /Senior Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4617164) Apply Behavioral Health Finance Analyst ... I/ II /Senior Salary $75,660.36 - $129,463.29 Annually Location Oxnard, CA...auditors. Oversees audits, interprets and assists with resolution to audit findings; + Plans, schedules and coordinates all aspects… more
- Penn Medicine (Bala Cynwyd, PA)
- …future each day. Are you living your life's work? **Hospital Compliance Analyst II ** Job Summary: + Responsible for the performance and validation of medical record ... Incumbent will also participate in performing coding research and other hospital-based audit activity that may be necessary in support of the Department mission.… more
- The County of Los Angeles (Los Angeles, CA)
- …procedures concerning program administration, ensuring compliance with Federal and State Medicare and Medicaid regulations for reimbursement claiming and maximum ... MENTAL HEALTH PROGRAM MANAGER II / EMERGENCY APPOINTMENTS HOMELESSNESS Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4659662) Apply MENTAL… 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
- LA Care Health Plan (Los Angeles, CA)
- Credentialing Specialist II Job Category: Administrative, HR, Business Professionals Department: Provider Data Management Location: Los Angeles, CA, US, 90017 ... net required to achieve that purpose. Job Summary The Credentialing Specialist II is responsible for managing their workload, addressing all functions for initial… more
- Centene Corporation (Austin, TX)
- …Trainer II should understand basic claims billing requirements and reimbursement + Conduct training needs analyses to determine specific training needs for ... of training programs and/or auditing tools for line of businesses including Medicaid, Medicare , MMP, DSNP and Ambetter for Texas. Candidates must reside in the state… more
- US Anesthesia Partners (Austin, TX)
- Overview The Accounts Receivable Representative II is responsible for collecting outstanding accounts receivable from third party payers; both government and ... Work s correspondence daily. + Maintain s basic proficiency with using spreadsheets. + Audit s adjustment requests and complete s when appropriate . + Resolve s… more
- Ventura County (Ventura, CA)
- …is responsible for billing and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare , and general ... and timely payment; + Reviews bulletins to identify new programs that may affect reimbursement for Medi-Cal and/or Medicare and prepares reports; + Serves as… more
- Medical Mutual of Ohio (OH)
- …and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Responsibilities** **Business ... with management, external vendors, and Information Systems to define, develop, test, audit and implement new business systems and processes. Identifies and solves… more
- Nuvance Health (Danbury, CT)
- …Reporting to the Special Associate Compliance Officer (SACO) Physician Audit & Billing, the Senior Inpatient Professional Auditor providesHospital Inpatient ... on auditing results. Effectively uses abstracting databases, internal and external audit results, QIO reports and revenue cycle edit/denial information. Effectively… more
- Highmark Health (Columbus, OH)
- …OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and ... coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure… 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 ... and payment variance. Ensures compliance with policies and directives issued by Medicare , Medicaid, Third Party Payers, and others as needed. + Maintains knowledge… more
- Trinity Health (Boise, ID)
- …management in order to facilitate correct and compliant charging and optimize reimbursement .. Communicates all audit findings with necessary parties. Analyzes ... will include but is not limited to: regulatory reviews, audit reviews of pre-service, time of service and post...business office operations. + Strong preference for knowledge of Medicare coding and reimbursement systems for inpatient… more
- Access Dubuque (Dubuque, IA)
- …which is why our benefit package includes: + Wellness programs + Education reimbursement + Personalized health insurance plans including dental and vision + Paid ... patient with a payment receipt. + Validates medical necessity (LMRP/LCD review) of Medicare and Non- Medicare cases to ensure clinical and financial clearance.… more
- Trinity Health (Sioux City, IA)
- …patient with a payment receipt. + Validates medical necessity (LMRP/LCD review) of Medicare and Non- Medicare cases to ensure clinical and financial clearance. ... benefits, release of information, waivers, ABNs, advance directives, etc.). May audit & record the patient's valuables, securing appropriate authorizations, if… more