- CVS Health (Scottsdale, AZ)
- …overseeing a team of 10 auditors. This role is pivotal in conducting and building Medicare Pharmacy Audit programs for our PBM clients. The ideal candidate will ... and external stakeholders. The ideal candidate will possess a strong understanding of Medicare regulations, pharmacy operations, and audit processes. You will be… more
- Elevance Health (Columbus, OH)
- ** Audit & Reimbursement III - Medicare Cost Report Audit ** **_Locations:_** _This is a virtual United States based position._ **National Government ... Medicare and Medicaid Services to transform federal health programs. The ** Audit and Reimbursement III** will support our Medicare Administrative Contract… more
- Henry Ford Health System (Troy, MI)
- …billing and coding records and the timely submission of documentation for Medicare Recovery Audit Contractors (RAC) and Third-Party Payer Audits. PRINCIPLE ... GENERAL SUMMARY: The Manager of Payor Audit is responsible for managing all third-party payer...both inter-departmental staff and multi-disciplinary teams. + Knowledge of Medicare , Medicaid, Blue Cross and other third-party payers billing… more
- 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
- Centene Corporation (Austin, TX)
- …Purpose:** Leads teams and individuals in the performance of internal audit activities, provides independent objective assurance and consulting services, builds ... strategic relationships between the Internal Audit department and other departments, and helps to promote...environment. + Lead the annual and ongoing planning of audit activities, budgets and resources. + Direct activities for… 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
- CVS Health (Lansing, 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
- 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
- Martin's Point Health Care (Portland, ME)
- …and Access) + Exceptional verbal and written communication + Demonstrable knowledge of Medicare guidelines, audit protocols and processes required + Broad and ... Summary The Manager, USFHP Compliance will assist the Director, Compliance and Medicare Compliance Officer (MCO) in ensuring Martin's Point (MP) US Family Health… more
- HCA Healthcare (Nashville, TN)
- …criteria is met in compliance with departmental policies and procedures + Review Medicare Recovery Audit Contractor (RAC) recoupment requests and process or ... appeal as appropriate + Compose technical denial arguments for reconsideration, including both written and telephonically + Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument +… 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
- 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 (OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Medical Mutual' s ... our members achieve their best possible health and quality of life. ** Medicare Sales Operations Specialist** Executes all end-to-end functions relating to the… 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
- Kelly Services (Coppell, TX)
- ** Medicare and Medicaid Facilities Enrollment Coordinator** **Kelly Services is looking for someone who has worked in** a healthcare facility, like a hospital, ... home health agency, **that has registered the facility** with Medicare and/or Medicaid to be able to bill the...to staff regarding enrollment processes and compliance standards. + ** Audit and Reporting:** + Conduct periodic reviews of enrollment… 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...of complex scenarios such as interim , self - audit , combined , and split billing etc. +… more
- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment, you will be an expert in risk adjustment coding and ... educational materials for providers and medical groups. + Participate in additional audit activities for CMS RADV as needed, including retrospective chart reviews. +… more