- Providence (OR)
- **Description** ** Recovery Audit Contract Representative \*Remote * Most states eligible.** Under the direction of ministry HIM management, HIM Audit ... Audit Tracking System for the ministry. The Audit Recovery Coordinator is the liaison between...years HIM related experience. + Experience with OIG, CMS, Medicare Fiscal Intermediary audits and other payer audits. +… more
- Molina Healthcare (NM)
- **JOB DESCRIPTION** **Job Summary** Responsible for reviewing Medicaid, Medicare , and Marketplace claims for overpayments; researching claim payment guidelines, ... billing guidelines, audit results, and federal regulations to determine overpayment accuracy...provider compliance. Interacts with health plans and vendors regarding recovery outstanding overpayments. **Job Duties** + Prepares written provider… more
- State of Maine, Bureau of Human Resources (Augusta, ME)
- …Estate Recovery , Casualty Recovery , and Insurance, Long Term Care and Recovery and Audit . The position supervises staff in each of these business units ... to the Department Finance Center monthly. * Works to resolve provider disputes of audit findings. * Provides monthly TPL recovery reports, Estate Recovery … more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …reviews documentation on all Observation accounts for carve-out observation hours, extended recovery , the charge coding of ED Visits and Injection and Infusion ... personnel with patient questions about itemized charges + Maintain reporting system of audit activities and identifies pattern and trending of results + Act as… more
- Health First (Rockledge, FL)
- …our regulatory agencies. Provide superior quality by managing and influencing the complex Medicare Advantage (MA) and Individual and Family Plans (IFP) recovery ... of programs to meet business objectives, CMS regulations and quality standards for Medicare Advantage and IFP Risk Adjustment. * Develop and manage quality assurance… more
- Ventura County (Ventura, CA)
- …and other auditors. Oversees audits, interprets and assists with resolution to audit findings; + Plans, schedules and coordinates all aspects of Annual Contract ... techniques used, equitable allocation of costs, and maximum cost recovery from State and federal entities; + Extracts and...were with Mental Health, Substance Use Services, and/or hospital Medicare /Medi-Cal cost reporting; OR one (1) year as a… more
- NHS Management, LLC (Ozark, AL)
- …offers you the unique opportunity to walk alongside patients on their road to recovery from many different conditions. As you care for and help patients achieve ... with internal controls and state and federal regulations. + Ability to audit resident accounts, assess accuracy and collectability of accounts receivable balances,… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- …accountable for coordinating a utilization review program which promotes effective cost recovery , quality of care and/or compliance with relevant federal and state ... care facilities for purposes of maximizing reimbursement revenue via Medicare Part B programs; + May review medical records...May testify in court; + May coordinate review and audit of occupational injury and/or disease disability cases for… more
- Molina Healthcare (Louisville, KY)
- …* Provides leadership, management, and vision necessary to maximize accurate overpayment recovery while driving prevention efforts and Cost of Care savings. * ... pre-pay and post-pay programs to grow overpayment identification coverage, drive recovery results, and manage administrative costs. * Under the general direction… more
- Stanford Health Care (Palo Alto, CA)
- …and payment variance. Ensures compliance with policies and directives issued by Medicare , Medicaid, Third Party Payers, and others as needed. + Maintains knowledge ... and procedures; updates staff and outside departments on government (Medi-Cal/Medicaid/ Medicare /VA) regulations and non-government payor medical and billing policies.… more
- Stanford Health Care (Palo Alto, CA)
- …EMTALA, the Stark Law, Conflicts of Interest, Gifts and Entertainment, and Medicare and Medicaid program requirements. + Develop written policies, procedures, and ... + Prepares annual and ad hoc reports for the Audit and Compliance Committee of the hospitals' Board of...to, HIPAA, Anti-Kickback Statute, EMTALA, the Stark Law, and Medicare and Medicaid program requirements. + Knowledge of general… more
- Molina Healthcare (NE)
- …* Claims Adjudication accuracy including configuration in QNXT (ie Claims Production, Audit , Production Vendor Oversight) for all lines of business. Claims Shared ... the production of claims including but not limited to the Corporate Recovery Team, Corporate Claims Compliance Team, Support Services, Enrollment and Billing,… more
- The County of Los Angeles (Los Angeles, CA)
- …rules and regulations and result in maximum revenue collection. Prepares Medicare and Medi-Cal cost reports and State mandated disclosure reports. Analyzes ... and adjusts billing rates to reflect cost changes and maximize cost recovery . Analyzes utilization of billing rates and/or contract allocations for appropriate… more
- Cedars-Sinai (CA)
- …RACs, government billed claims and inpatient stay reviews, and commercial payer audit and recovery programs. Communicates trends and presents executive updates ... settlement conferences and trials. Maintains and monitors high success rates in the audit program. + Provides reporting and feedback to Revenue Cycle and clinical… more
- HCA Healthcare (Webster, TX)
- …items in these accounts + You will be responsible for completing assigned Medicare , Year-End and Internal Audit work papers. Responsible for answering questions ... center provides nationally-recognized care in the prevention, diagnosis, treatment and recovery of cardiovascular diseases. HCA Houston Healthcare Clear Lake offers… more
- Virginia Mason Franciscan Health (Seattle, WA)
- …etc) - Hospital/clinic insurance billing, follow-up/denials management, auditing and appeals, recovery audit response - Advanced revenue cycle analytics Work ... principles and practices related to healthcare finance/revenue cycle management, including Medicare , DSHS, Third-party payers and other agencies, as well as a… more
- Hackensack Meridian Health (Hackensack, NJ)
- …by:** **I. Peer-to Peer (P2P) Concurrent appeals** **ii. Written Concurrent appeals** **iii. Recovery Audit Contractors & levels of appeal** **iv. Root cause ... status based on length of stay, level of care requirements** **and** ** Medicare regulations, and Major Complications or Comorbidities (MCC) / Complications or**… more
- The County of Los Angeles (Los Angeles, CA)
- …procedures concerning program administration, ensuring compliance with Federal and State Medicare and Medicaid regulations for reimbursement claiming and maximum ... recovery costs for directly operated billable services. Develops and...methods as necessary. Oversees audits and the implementation of audit recommendations for programs managed. Represents managed programs in… more
- Mohawk Valley Health System (Utica, NY)
- …Provide peer-to-peer payor review in collaboration with attending physicians. + Support Recovery Audit Contractors (RAC's). + Assist with mitigating barriers to ... clinical variability throughout the medical staff. + Assist case managers with Medicare and Medicaid appeals and Administrative Law Judge (ALJ) testimonies. Act as… more
- Project Renewal, Inc. (Brooklyn, NY)
- …Withdrawal Services, (MSOWS), Chemical Dependency Crisis Service (CDCS), and Outpatient Recovery Center available to them throughout the agency. Essential Duties & ... breakdowns and assign new clients to Case Managers. + Audit client charts weekly to ensure adherence to regulatory...Advises clients of entitlement possibilities and refers them for Medicaid/ Medicare , Public Assistance, & Food Stamps as needed. +… more