- Baptist Memorial (Memphis, TN)
- …Preferred: PREFERRED 5 years of healthcare care experience and 3 years in Medicare billing environment. Previous audit experience, knowledge of InterQual and ... Summary Medicare / Medicaid Appeals Registered Nurse reviews and...Coordinator-RAC TPE Facility: BMHCC Corporate Office Department: HS Revenue Audit Corporate Category: Finance and Accounting Type: Non Clinical… more
- Elevance Health (Columbus, OH)
- …Medicare and Medicaid Services to transform federal health programs._ The ** Audit and Reimbursement Senior** will support our Medicare Administrative Contract ... + Requires a BA/BS and a minimum of 8 years of audit /reimbursement or related Medicare experience; or any combination of education and experience which would… more
- Elevance Health (Columbus, OH)
- … Medicare and Medicaid Services to transform federal health programs._ The ** Audit and Reimbursement Lead** will support our Medicare Administrative Contract ... Requires a BA/BS degree and a minimum of 8 years audit /reimbursement or related Medicare experience which includes previous experience at a Senior Auditor level… more
- Elevance Health (Boston, MA)
- …as needed. **Requirements:** + a BA/BS and a minimum of 8 years of audit /reimbursement or related Medicare experience; or any combination of education and ... **Shift:** Monday-Friday 8:30am-5:00pm **Responsible for coordinating all activities of an audit or reimbursement team in the initiation and completion of… more
- CVS Health (Southfield, MI)
- …levels to drive decision-making and influence ethical and compliant outcomes. * Monitor and audit as outlined in Medicare Compliance Work Plan and direct other ... business, analytical and communication skills to support, manage and develop Medicare and Medicaid compliance programs and processes that promote compliant and… more
- Walmart (Orlando, FL)
- …process Medicare orders to ensure compliance; and interpreting and documenting Medicare audit documents. + Ensures fulfillment of pharmacy prescriptions in a ... documentation; and maintaining a safe and clean work environment. + Complies with Medicare and Medicaid policies and procedures by implementing and adhering to rules… more
- Walmart (Orlando, FL)
- …process Medicare orders to ensure compliance; and interpreting and documenting Medicare audit documents. + Ensures fulfillment of pharmacy prescriptions in a ... documentation; and maintaining a safe and clean work environment. + Complies with Medicare and Medicaid policies and procedures by implementing and adhering to rules… more
- Humana (Louisville, KY)
- …DSNP Medicare Operations. Serve as the subject matter expert on DSNP Medicare Operations. + Develop audit methodology and perform auditing and monitoring ... partners, Law, and Enterprise Compliance associates and leaders with regard to DSNP Medicare Operations. + Develop and track compliance metrics to help monitor and… more
- Charter Care Health Partners (Providence, RI)
- …year; submit executive summary and action plan to the GME Office + Prepare Medicare Audit documents, per the GME Office's instructions + Manage fellow financial ... program's New Fellow Orientation (print documents, etc.) + Research forms for Medicare reimbursements for fellowships with dedicated research time, if applicable +… more
- Medical Mutual of Ohio (OH)
- …remote opportunity_** . **_Eastern & Central Time Zones preferred. Extensive Medicare Part D experience is highly sought after._** **Responsibilities** ** Medicare ... to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and Medicare Part...Part B inquiries, grievances, and CTMs, updating tracking documents, audit research items, and marketing material reviews. . Assists… more
- Dignity Health (Phoenix, AZ)
- …**Responsibilities** Develops operates and administers the regulatory compliance program for both Medicare Advantage (Part C) and Medicare Part-D plan activities ... Company. Reports directly to the Plan CEO and the Audit and Compliance Committee of the Board of Directors...Develops and monitors the implementation of and compliance with Medicare policies and procedures through the creation and implementation… more
- AdventHealth (Altamonte Springs, FL)
- …Manager with the preparation of work papers for the filing of the annual Medicare , Medicaid, and Champus/Tricare cost reports, audit preparation and other cost ... preparation and submission of accurate and timely cost reports as required by Medicare , Medicaid and other State or Federal agencies for the Adventist Health… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Implements and manages ... the implementation and daily operation of the Medicare Advantage Compliance Program and all compliance-related activities for the Company's Medicare Advantage… more
- CommuniCare Health Services Corporate (Indianapolis, IN)
- Medicare Biller The CommuniCare Family of Companies currently owns/manages over 130 World-Class Nursing and Rehabilitation Centers, Specialty Care Centers, and ... living communities. CommuniCare Health Services is currently recruiting a Medicare Biller for our Central Billing Office in Cincinnati,...+ Verify receipt of monthly triple check forms and audit for accuracy per triple check policy prior to… more
- The Cigna Group (Bloomfield, CT)
- **Job Summary:** The Business Analytics Senior Advisor position within the Medicare Growth Analytics Team is an opportunity to provide leadership on our analytics ... strategy, to support our broader Medicare Growth team and provide actionable insights and analytics. This role will work with a team of professionals on setting and… more
- CVS Health (Nashville, TN)
- …talent! We have an exciting opportunity available for highly motivated individuals as Medicare Sales Specialist. The position will be a part of a specialized team ... who will focus on educating existing Medicare members on available plan offerings to help meet...and rapid disenrollment's. + Adherence to call center quality audit programs. + Highest levels of member satisfaction as… more
- Vanderbilt University Medical Center (Nashville, TN)
- …to senior business operational leaders and physician leadership regarding: + Audit results to outside regulators, attorneys, and other stakeholders; + Documentation ... of third-party audits and appeals related to disputed issues. Prepares slides of audit results for inclusion in presentations to unit leaders and executive steering… more
- The Cigna Group (Bloomfield, CT)
- …is responsible for developing solution changes for the ongoing needs of CMS Medicare Risk Adjustment processes and systems. The ** Medicare Risk Adjustment ... will have a primary focus on supporting Risk Adjustment compliance and audit projects. **Principal Duties:** + Perform required tracking and reporting for all… more
- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Provider Documentation Trainer and Auditor, you will be an expert in risk adjustment coding and documentation, ... educational materials for providers and medical groups. + Participate in additional audit activities for CMS RADV as needed, including retrospective chart reviews. +… more
- Robert Half Accountemps (Panorama City, CA)
- …and collections. Work closely with various insurance providers including HMO, PPO, Medicare , and Medi-Cal. Audit and review denial trends, identifying potential ... collections, including working with different types of insurances including HMO, PPO, Medicare and Medi-Cal. The ideal candidate will be experienced in auditing,… more