- HCA Healthcare (Plano, TX)
- …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
- Dignity Health (Bakersfield, CA)
- …errors. The Recovery Manager works in close coordination with internal audit , provider dispute resolution, and finance to maximize cost recovery , reduce ... or GED + Minimum 5 years of progressive experience in healthcare claims recovery , payment integrity, or post-payment audit functions, preferably within a… more
- Saint Francis Health System (Tulsa, OK)
- …to enhance audits and provides continuous monitoring. Provides oversight to sales tax recovery for taxable items utilized directly on Medicare and Medicaid ... assistance is available to support the transition. Job Summary: The Senior Internal Audit Analyst plays a critical role in evaluating and improving the effectiveness… more
- Molina Healthcare (Kearney, NE)
- JOB DESCRIPTION Job Summary Provides support for claims recovery activities including researching claim payment and billing guidelines, audit results, and ... and provider compliance. Collaborates with health plans and vendors to facilitate recovery of outstanding overpayments. Monitors and controls backlog and workflow of… more
- Stanford Health Care (Palo Alto, CA)
- …the primary executives responsible for reporting to the Board of Directors, Audit , Compliance and Enterprise Risk Committee and Finance & Investment Committee. ... including CEO, CFO and COO. Provide expertise and consultation on complex accounting, audit and tax issues. Review and approve the issuance of consolidated financial… more
- Stanford Health Care (Palo Alto, CA)
- …complete and accurate capture of all legitimate reimbursement opportunities. + Oversee Medicare and Medi-Cal audit processes, addressing inquiries and pursuing ... and regulatory reports to government agencies, including but not limited to: * Medicare and Medi-Cal cost reports *Financial disclosures to the Department of Health… more
- Stanford Health Care (Palo Alto, CA)
- …billing, including federal and state regulations and guidelines, CMS (Centers for Medicare and Medicaid Services) and OIG (Office of Inspector General) compliance ... + Conducts defensive charge audits, self-pay/patient requests, or other special audit projects, as requested, comparing itemized bills to corresponding medical… more
- NHS Management, LLC (Athens, 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 (Middletown, 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
- Bassett Healthcare (Hamilton, NY)
- …via mail, phone, or MyBassett to meet patient satisfactions. + Takes a lead in service recovery and acts as a service liaison in the moment. + Acts as a trainer for ... and is entered or scanned into the system accurately as monitored by system audit + Accurate confirmation of attending PCP and Billing PCP, when appropriate. +… 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
- 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
- MyFlorida (Gainesville, FL)
- …promote strong and economically self-sufficient families, and advance personal and family recovery and resiliency. Within DCF, the Substance Abuse and Mental Health ... of a comprehensive statewide system of care for the prevention, treatment, and recovery of children and adults with serious mental illnesses or substance use… more
- Veterans Affairs, Veterans Health Administration (Denver, CO)
- …crucial to the accuracy of the facility database as well as all cost recovery programs. Performs a comprehensive review of the patient health record to abstract ... records for compliance with The Joint Commission requirements, Centers for Medicare & Medicaid Services (CMS), and/or health record documentation guidelines.… more
- Banner Health (Tucson, AZ)
- …an innovative leader in health care, Banner Plans & Networks (BPN) integrates Medicare and private health plans to reduce healthcare costs while keeping our members ... help support the Clinical Performance Team in a **temporary assignment** during the annual audit time frame of **January 2026 - June 2026** . You will be requesting… 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
- LifeCenter Northwest (Bellevue, WA)
- …and/or local laws and/or regulations, including those of the Center for Medicare Services (CMS), Uniform Anatomical Gift Act (UAGA), compliance with the Association ... in relation to department performance. + Responsible for on-going departmental audit preparation. + Develops, manages, and leads the departmental budget. Routinely… more
- HCA Healthcare (Webster, TX)
- …budgets. 9. Prepares workpapers to assist Reimbursement staff in filing annual Medicare / Medicaid Cost Reports. 10. Prepares workpapers to facilitate Internal ... Audit staff in their review of internal control procedures...provides nationally-recognized care in the prevention, diagnosis, treatment and recovery of cardiovascular diseases. HCA Houston Healthcare Clear Lake… more
- Nuvance Health (Danbury, CT)
- …denied or downgraded coverage determinations by managed care, commercial payers, and recovery audit contractors. * Maintain and Model the organization's values ... with clinical documentation requirements * Working knowledge of Centers for Medicare and Medicaid Services rules and regulations, and interest in building… 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