- Medical Mutual of Ohio (OH)
- …to meet and achieve compliance with regulatory requirements. **Responsibilities** ** Medicare Sales Operations Specialist ** + Manages receipt, tracking and ... achieve their best possible health and quality of life. ** Medicare Sales Operations Specialist ** Executes all end-to-end...the investigation of sales violations and complaints to the Medicare Advantage Sales Compliance area issued via… more
- Robert Half Finance & Accounting (Bridgewater, NJ)
- …about any discrepancies or issues with billing + Understand and adhere to all Medicare Compliance policies + Stay updated on current Medicare billing ... Description + Handle billing for Medicare patients, ensuring all claims are submitted correctly...billing trends + Assist with internal audits related to Medicare billing practices Requirements The ideal candidate will have… more
- VNS Health (Manhattan, NY)
- OverviewThe Medicare Enrollment Specialist educates consumers who have reached out to VNS Health Plans and existing VNS Health Plans MLTC members about the ... MAPD and/or DSNP products. Achieves monthly conversion rate and quality/ compliance metrics. Works under general supervision. Compensation Range:$70,200.00 -… more
- Healthfirst (NY)
- …internal policies/procedures and job aids on a regular basis to ensure compliance with regulatory requirements and consistence with actual activities + Support ... product management leadership in preparing and conducting product and lines of business (LOB) presentations and training to internal and external audiences + Plan, schedule, monitor, and report on activities related to a project or assignment; ensure… more
- PruittHealth (Norcross, GA)
- …with members of own and other teams to communicate effectively and ensure compliance with cross-team responsibilities. 17. Carries out all duties with a "Commitment ... to Caring" attitude in accordance with PruittHealth's mission, vision, and philosophy. **KNOWLEDGE, SKILLS, ABILITIES:** * In-depth knowledge of various billing documentation requirements, the patient accounting system, and various data entry codes to ensure… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- The Medicare Billing and Follow-up Representative are responsible for the compliant, accurate and timely billing and follow-up of all hospital Medicare and ... limited as other tasks may be assigned. + Submit Medicare / Medicare Advantage plan claims both electronic and...leve ls , quality of work output , in compliance with established CRH ' s policy and standards… more
- Point32Health (Canton, MA)
- …business performance needs of each market. All responsibilities extend to any new Medicare markets should Point32Health choose to expand its footprint in the future. ... questions that may arise during desk review, review of Medicare Plan Finder (MPF) for accuracy, etc. + Support...business functions, etc. + Oversee or collaborate with Product Specialist to manage Benefit Adjudication Committee meetings and other… more
- Lowe's (Charlotte, NC)
- …treatment to an appropriate resolution. Apply medical treatment guidelines for future Medicare -covered expenses. The candidate will work directly for a Fortune 100 ... caseload of 65 including review of claims identified for Medicare Set-Aside. **What you will do** + Manage an...Rehabilitation Registered Nurse + CDMS - Certified Disability Management Specialist + COHN - Certified Occupational Health Nurse or… more
- Medical Mutual of Ohio (OH)
- …best possible health and quality of life. **Responsibilities** **Medical Coding Compliance Specialist I** Optimizes/reviews documentation for the application of ... as corporate audits. . Performs other duties as assigned. **Medical Coding Compliance Specialist II** Optimizes/reviews documentation for the application of risk… more
- UCLA Health (Los Angeles, CA)
- …can do all this and more at UCLA Health. As member of the Medicare Advantage Risk Adjustment leadership team, the Assistant Director of Risk Adjustment is ... risk adjustment department. You will be responsible for coordinating mock RADV audits and compliance audits with the compliance officer and the manager of coding… more
- Banner Health (AZ)
- …a direct interface with the Arizona Medicaid Agency (AHCCCS), Center of Medicare and Medicaid Services (CMS), Association for Community Affiliated Plans (ACAP), and ... operating procedures are followed, necessary controls are effective and efficient, and compliance with current laws and regulations is achieved 4. Sets strategic… more
- Ventura County (Ventura, CA)
- …and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare , and general insurance reimbursement ... Medicare and prepares reports; + Serves as lead biller/ specialist to the department; and + Performs other related...with billing and processing claims for timely reimbursement and compliance with Medi-Cal, Medicare , and general insurance… 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
- Hackensack Meridian Health (Hackensack, NJ)
- …transform healthcare and serve as a leader of positive change. The **Coding Compliance Specialist ** performs reviews by validating accuracy of the coding billed ... on departmental need.** **Responsibilities** A day in the life of an **Coding Compliance Specialist ** at Hackensack Meridian _Health_ includes: + Must code a… more
- Medical Mutual of Ohio (Toledo, OH)
- …of risk adjustment coding for ACA (Affordable Care Act) and MA ( Medicare Advantage) with assigning and maintaining diagnoses medical codes. Evaluates requests for ... (Registered Health Information Technician) and/or + CCS/CCS-P (Certified Coding Specialist /Physician-based + CRC (Certified Risk Adjustment Coder) or other industry… more
- LA Care Health Plan (Los Angeles, CA)
- Regulatory Compliance Quality Audit Specialist Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... achieve that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of the… more
- Insight Global (San Antonio, TX)
- Job Description Insight Global is looking for a Compliance Specialist to support a health insurance company. The Compliance Specialist is responsible for ... Insurance (TDI) regulations, the Office of Inspector General (OIG) Compliance Plan, and the Centers for Medicare ...(OIG) Compliance Plan, and the Centers for Medicare and Medicaid Services (CMS) regulations - Understanding/familiarity with… more
- University of Utah (Salt Lake City, UT)
- Details **Open Date** 11/19/2024 **Requisition Number** PRN40385B **Job Title** Compliance Specialist **Working Title** Safety Compliance Specialist ... Date (Note - Posting may close at any time)** **Job Summary** Provides compliance related coding reviews and auditing of faculty and physician documentation. The… more
- University of Utah (Salt Lake City, UT)
- Details **Open Date** 01/10/2025 **Requisition Number** PRN40939B **Job Title** Compliance Specialist **Working Title** Compliance Specialist **Job ... research protocols, provides technical support, and regulatory guidance. The compliance officer conducts regulatory audits of approved research protocols,… more
- Molina Healthcare (Hattiesburg, MS)
- …require 50%+ travel around southern Mississippi.** **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist , Quality Interventions / QI Compliance contributes to ... or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance . + Acts as a lead specialist to provide project-,… more
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