- Henry Ford Health System (Troy, MI)
- …medical, billing and coding records and the timely submission of documentation for Medicare Recovery Audit Contractors (RAC) and Third-Party Payer Audits. ... 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
- Hartford HealthCare (Farmington, CT)
- …and time sensitive; Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractor (RAC), Executive Health Resources (EHR), appeals and legal ... and payer medical record audits. Provides oversight for designated regulatory audit activity throughout HHC HIM. Oversees and monitor payment protocol through… 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
- Medical Mutual of Ohio (Brooklyn, OH)
- …effectiveness. + Reviews current procedures and revises to ensure for accuracy. Provides audit support and provides support in Disaster Recovery (DR) test. + ... ensure completion. + Reviews current procedures and revises to ensure for accuracy. Provides audit support and provides support in Disaster Recovery (DR) test. +… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …protocols which align with Bon Secours Mercy Health's overall compliance audit and compliance responsibilities relative to hospital revenue cycle services performed ... procedures for the development of compliance internal monitors and audit protocols and the prevention of fraud, waste and...hospital revenue cycle risk areas highlighted by the OIG, Medicare , State Medicaid, State Insurance Fraud; Managed Care or… more
- MetroLink (Los Angeles, CA)
- …cyber security solutions required to meet business objectives. + Review and audit technical implementations of physical security solutions required to meet business ... + Experience in developing Business Continuity Plans and Disaster Recovery Plans. + Strong understanding of IP, TCP/IP, and...exceeds $50,000, be added to your Federal, State, and Medicare taxable earnings for W-2 reporting. This amount is… more
- Eastern Connecticut Health Network (Vernon, CT)
- …audits that include but is not limited to Additional Documentation Requests (ADR), Recovery Audit Contractors (RAC), and Third-Party Liability (TPL). + Responds ... Administrator to coordinate department activities. Supports the department's efforts to audit , track and trend patient outcomes, analyzes data, develops and… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …personnel with patient questions about itemized charges . Maintain reporting system of audit activities and identifies pattern and trending of results . Act as ... diagnoses and procedures by following the ICD-10-CM, Uniform Hospital Data Set, Medicare , Medicaid, and other fiscal intermediary guidelines . Report trends and… more
- NHS Management, LLC (Pleasant Grove, 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
- 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
- Molina Healthcare (Meridian, ID)
- …for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. ... order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with… more
- Molina Healthcare (Miami, FL)
- …for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. ... coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position...+ Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. + Understanding of… more
- Molina Healthcare (KY)
- …for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. ... order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with… 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
- 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
- Commonwealth Care Alliance (Boston, MA)
- …and directly contributes to the plan's achievement of quality incentives such as the Medicare Star Rating system and the recovery of the Quality Withhold. Major ... Previous HEDIS data collection experience highly preferred + Medical Record Audit experience preferred (medical record review and capturing/ documenting appropriate… 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
- US Anesthesia Partners (Dallas, TX)
- …including insurance verification, claims submission, transaction processing, revenue recovery , denial management, self-pay collections, and other accounts receivable ... including: + Developing and managing the relationship between the direct reports, audit team and their operational counterparts. + Identify and work with the… more