- Novo Nordisk Inc. (Plainsboro, NJ)
- …Inflation Reduction Act ("IRA") processes and compliance activities for the Medicare Drug Negotiation Program. Ensures accurate and timely input and implementation ... support for SOX inquiries and ensure adherence to SOX controls. Performs post audit reviews and analysis of 340B PHS chargebacks and MFP rebates Ensure timely… more
- Elevance Health (Miami, FL)
- …Medicaid Services to transform federal health programs. The ** Audit and Reimbursement Senior ** will support our Medicare Administrative Contract (MAC) ... ** Audit & Reimbursement Senior **...** Audit & Reimbursement Senior ** **_Location:_** _This role enables...Services). The Audit and Reimbursement Senior will support contractual workload involving complex Medicare… more
- Saint Francis Health System (Tulsa, OK)
- …area. + Relocation assistance is available to support the transition. Job Summary: The Senior Internal Audit Analyst plays a critical role in evaluating and ... software, and data analytics platforms. Working knowledge of healthcare billing and reimbursement processes, particularly related to Medicare and Medicaid is… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …staff, Benefits Administration staff, Provider Audit , Network Administration and/or Medicare Advantage staff, and entry level Reimbursement Analyst by ... Medicare Advantage must have working knowledge of Medicare enrollment guidelines and reimbursement . **Licenses and...well as coordinating projects and time frames with less senior reimbursement staff. + Accountable for complying… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Financial Compliance Audit , $10,000 SIGN ON BONUS Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 ... to achieve that purpose. Job Summary Manager, Financial Compliance Audit (Finance) has a $10,000 SIGN-ON BONUS. This role...(DMHC), Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and other federal and… more
- Sutter Health (Sacramento, CA)
- …+ Understanding of hospital-based outpatient charging and coding + Knowledge of Medicare APC and OPPS reimbursement structures + In-depth knowledge of ... at communicating effectively with all levels of the organization, especially senior leadership and department heads. + Demonstrates skilled ability and comfort… more
- Omaha Children's Hospital (Omaha, NE)
- …DSH reporting, and other agency reporting over net patient revenue and reimbursement . Oversees general ledger accounts and ensures accuracy of financial statements ... members. **Essential Functions** Cost Reporting + Coordinates preparation of all Medicare and Medicaid cost reports. + Analyzes, interprets, and utilizes statistics… more
- Stanford Health Care (Palo Alto, CA)
- …accurate capture of all legitimate reimbursement opportunities. + Oversee Medicare and Medi-Cal audit processes, addressing inquiries and pursuing appeals ... is a Stanford Health Care job.** **A Brief Overview** The Director of Reimbursement is a key leadership role within the Controller's Office, responsible for… more
- University of Southern California (Alhambra, CA)
- …(nursing or allied health), coding, provider billing, medical records, charge audit environment, CDM maintenance, Medicare /Medicaid reimbursement , managed ... the billing system and CDM management tools . The Senior RI Specialist shall ensure that the Chargemaster (CDM)...with inpatient and outpatient billing requirements (UB-04) and CMS Medicare reimbursement methodology. + Req Knowledge of… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …MA, RI, CT)** Reporting to the Director of Billing Compliance, the Senior Billing Compliance Reviewer ensures the integrity, accuracy, and regulatory compliance of ... payer, and institutional billing guidelines as well as national coding guidelines. The Senior Reviewer will assist in the development and execution of the annual… more
- University of Rochester (Brighton, NY)
- …on relevant reimbursement and billing issues and requirements (including CMS, Medicare Advantage, and New York State Medicaid). Stays abreast of Medicare ... the goals and expectations established for the Office of Counsel, the Senior Counsel identifies, analyzes and provides legal guidance and services on complex… more
- Centene Corporation (Jefferson City, MO)
- …audits related to Risk Adjustment processes. Ensures visibility by way of reporting out audit deliverables and risk related to each audit . + Serves as the ... of contact for external audits, and correspond with auditors related to audit acknowledgement, deliverables timelines and other inquiries. + Manages external … more
- Catholic Health (Buffalo, NY)
- …budget impacts on Catholic Health (CH), reviewing opportunities and the monitoring of reimbursement . The Manager assists Senior Leadership with the review and ... years progressive experience in health care finance + Extensive understanding of Medicare and Medicaid regulations, cost reports, reimbursement and financial… more
- Centene Corporation (Austin, TX)
- …candidate will have:_** + **_Knowledge of dual contract requirements (eg, Medicare -Medicaid plans)_** + **_Experience managing external audits and communicating with ... clear, actionable feedback_** + **_Skilled in developing and maintaining audit reporting, including tracking volume, identifying risks, and analyzing trends_**… more
- Beth Israel Lahey Health (Woburn, MA)
- …at the Beth Israel Deaconess Medical Center (BIDMC), the Revenue Integrity Senior Analyst contributes to Revenue Integrity and Coding oversight at the enterprise, ... compliance with applicable coding and billing guidelines, and optimization of reimbursement . * Support departments with analyzing services for coverage and … more
- Banner Health (Phoenix, AZ)
- …As a ** Senior Financial Analyst,** you will be responsible for pharmacy reimbursement , 340B pricing, Medicare Fair Price and Medicare Transaction ... reviews, and risk summaries; as well as monitoring federal price updates, audit flags, and regulatory changes functioning as the primary financial interpreter for… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Business Operations Analyst assumes a pro-active approach in ensuring the accuracy and integrity of ... analyses and problem resolution to meet business operational requirements for Medicare Advantage(MA), Affordable Care Act (ACA) & Medicaid Lines of Business… more
- Molina Healthcare (UT)
- **JOB DESCRIPTION** **Job Summary** Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements ... related to but not limited to coverage, reimbursement , and processing functions to support systems solutions development and maintenance. This role includes… more
- CommonSpirit Health (Phoenix, AZ)
- **Job Summary and Responsibilities** The remote Senior Coder acts as a lead coder for their designated team. This position will train staff on department policies, ... procedures, systems and correct coding requirements. The Sr. Coder additionally will audit Coders, fill in for out-of-office Coders, and make recommendations to… more
- University of Southern California (Alhambra, CA)
- …specific to ICD-10-CM, ICD-10-PCS, CPT/HCPCS, DRGs, APCs, and Modifiers-from Medicare , Medi-Cal, MAC, RAC, and commercial insurance companies -when there ... and an argument and follow up with the PFS about possible reimbursement . Identifies, analyzes, and researches frequent root causes of denials and develops… more
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