- Point32Health (Canton, MA)
- … Medicare Plan Finder (MPF) for accuracy, etc. + Support other annual regulatory submissions as necessary, eg, Medicare Supplement product filing with state ... subject matter expertise, as needed, on matters related to product design, regulatory requirements, and implementation feasibility. The Senior Manager may also lead… more
- Hackensack Meridian Health (Paramus, NJ)
- …healthcare and serve as a leader of positive change. The ** Regulatory Specialist ** is responsible for ensuring compliance with Federal, State, and Local ... assigned clinical trials. **Responsibilities** A day in the life of a ** Regulatory Specialist ** at **Hackensack Meridian** **_Health_** includes: + Organizes and… more
- Penn Medicine (Philadelphia, PA)
- …compliance activities and outcomes. Ensures that all initiatives are in compliance with accrediting, regulatory , and institutional standards Maintains the ... hospitals and its leaders and staff to ensure full compliance with state licensure regulations, hospital conditions of participation...to any necessary follow-up of both announced and unannounced regulatory body site visits with a focus on the… more
- CaroMont Health (Gastonia, NC)
- …HCC coding issues. Work with payer representatives who audit HCC coding for Managed Medicare plans and participate in the sharing of those audits with staff and ... that impact coding, such as 3M's Ambulatory Module Research payer guidelines or regulatory guidelines that impact coding (ICD10 or CPT) and provide education for… more
- LA Care Health Plan (Los Angeles, CA)
- …units in audit universe preparation and validation. Assists in document preparation for regulatory and internal audits. Regulatory compliance : Works closely ... Customer Solution Center Compliance Audit Specialist II Job Category:...the guidelines and protocols to ensure readiness for all regulatory audits. This position will develop, with the assistance… more
- Ventura County (Ventura, CA)
- …and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare , and general insurance reimbursement ... they effectively lead and train billers on Managed Care, Medicaid, Medi-Cal, Medicare , and Commercial Insurance, ensuring regulatory adherence and operational… more
- Axis (New York, NY)
- …request for candidates taking part in the selection process. AXIS Capital Claims Compliance Specialist , Claims Shared Services- Job Description AXIS is seeking a ... Claims Quality Assurance and Compliance Specialist , Claims Shared Services to join...Claims with an immediate focus on Adjuster Licensing and Medicare Compliance . The successful candidate is a… more
- Trinity Health (Livonia, MI)
- …or all hours being remote. This role is within the Integrity and Compliance department of IAS in the professional services Center of Excellence, providing support ... for the seven elements of an effective compliance program. This role is primarily responsible for the...services which relies on a thorough understanding of the Medicare Physician Fee Schedule, Medicare Claims Processing… more
- CareOregon (Portland, OR)
- …for remote positions must reside in Oregon or Washington. Job Title Sr Compliance Specialist Exemption Status Exempt Management Level n/a Direct Reports n/a ... role, but you must reside in Oregon or Washington. Job Summary The Sr Compliance Specialist is responsible for supporting administration of compliance … more
- Trinity Health (Livonia, MI)
- …HMs for questions related to health record documentation, coding, billing, and general regulatory compliance . Works on special compliance related projects, ... being remote. This role is within the Integrity and Compliance department of IAS in the professional services Center...services which relies on a thorough understanding of the Medicare Physician Fee Schedule, Medicare Claims Processing… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Compliance Resource Specialist (CRS) must have a broad knowledge and understanding of billing compliance as it relates to the Federal ... billing and reimbursement. Reporting to the Director of Hospital Compliance , the responsibilities include routine clinical documentation monitoring, reviews,… more
- Sutter Health (Sacramento, CA)
- …to ensure sustainable operational processes and internal controls are implemented in compliance with state and federal regulatory requirements. Collaborates with ... operational units and all levels of management to ensure operational and procedural compliance with legislative and regulatory criteria. Serves as a subject… more
- Molina Healthcare (AZ)
- …have that experience updated on your resume.** **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist , Quality Interventions / QI Compliance contributes to one ... or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance . + Acts as a lead specialist to provide project-,… more
- Molina Healthcare (MA)
- …occasional support for member-focused quality initiatives.** **KNOWLEDGE/SKILLS/ABILITIES** The Specialist , Quality Interventions/ QI Compliance contributes to ... provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities. **The focus of this position will be member outreach… more
- Ventura County (Ventura, CA)
- …and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare , and general insurance reimbursement ... Medical Billing Specialist I/II Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4658466) Apply Medical Billing... and audit issues and work progressively with the compliance office to identify and resolve regulatory … more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Under direct supervision, ... into the various modules of the Provider Data Management System. Supports compliance with standards set by individual states, federal and accrediting organizations… more
- LA Care Health Plan (Los Angeles, CA)
- Product Solutions Specialist II Job Category: Sales & Marketing Department: Commercial and Group Product Management Location: Los Angeles, CA, US, 90017 Position ... to achieve that purpose. Job Summary The Product Solutions Specialist II is focused on providing end to end...and or initiatives through the management of contracts and regulatory filings. Collaborate with leadership to develop the … more
- NHS Management, LLC (Springdale, AR)
- … Specialist Consultants, Internal Auditor, or any other corporate or regulatory compliance consultant. Communicates progress toward goals and ongoing ... Specialist Consultants, Internal Auditor, or any other corporate or regulatory compliance consultant. Communicates progress toward goals and ongoing… more
- Health First (Rockledge, FL)
- …demographics information, and secure the required forms to meet compliance with regulatory policies. 3. Perform Medicare compliance review on all ... Inc. by achieving sustainable levels of internal and external customer service, regulatory compliance , and financial performance within the revenue cycle.… more
- VNS Health (Manhattan, NY)
- …Advantage (MA), Fully Integrated Dual Advantage (FIDA) and Select Health. Ensures regulatory compliance , timeliness requirements and accuracy standards are met. ... You Will Do + Develops and maintains current knowledge of state and federal regulatory requirements related to all aspects of grievances and appeals for Medicare … more