- Commonwealth Care Alliance (Boston, MA)
- …the Sr. Director, TPA Management and Claims Compliance, the Payment Integrity (PI) Recovery Analyst will assist in the development of a strategic roadmap to recover, ... The individual will optimize pre/post claims auditing and claim recovery programs that will drive incremental value year over...have):** + 7+ years of Healthcare experience, specific to Medicare and Medicaid + 7+ years progressive experience in… 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
- Commonwealth Care Alliance (Boston, MA)
- …the privacy and security related activities of the CCA Executive Leadership Compliance, Audit & Enterprise Risk ("CAER") Council and the Board of Directors' Audit ... IT to develop, implement, administer, and, on an ongoing basis, audit system-wide requests for access/disclosure verification procedures that reasonably verify the… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Working under general ... combinations, inherent charges, provider supporting documentation, etc.** + **Documents audit results including denial reasons, erroneous activities, etc. and… more
- MetroLink (Los Angeles, CA)
- …of the payables system, taking advantage of system capabilities. + Enter and audit invoices or bills for compliance against purchase orders and requisitions. + Track ... exceeds $50,000, be added to your Federal, State, and Medicare taxable earnings for W-2 reporting. This amount is...of Oracle architecture, advanced topics, high availability and disaster recovery solutions, mentorship.) + None of the above 06… 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
- 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
- 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
- Centene Corporation (Phoenix, AZ)
- …one or more of the following areas: Formulary Management, Pharmacy Audit and Recovery , Pharmacy Service Center, Medicare Part D/Part B, Appeals, Medicare ... Clinical Pharmacists or Regional Medical Director on related issues. + Prior Authorization Medicare Part D and Part B + Tracks and triage coverage determination… more
- Bassett Healthcare (South Kortright, 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 ... is entered or scanned into the system accurately as monitored by system audit Accurate confirmation of attending PCP and Billing PCP, when appropriate. Assures… more
- Molina Healthcare (Louisville, KY)
- …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
- Carle (Urbana, IL)
- …to identify billing errors. + Provides continuous feedback to staff and management regarding audit outcomes. + Performs or assigns tasks as needed in the absence of ... IT to improve system processes. + Performs customer service recovery as needed and assures high quality customer service...patient access and insurance verification. + Ensures completion of Medicare Secondary Payer forms to optimize Medicare … more
- Insight Global (Long Beach, CA)
- …(Medicaid, Medicare , and Marketplace). - Healthcare industry experience. - Audit certification a plus CBCA, CBCLA, CBRA. - Healthcare continuity certification a ... with critical stakeholders/third parties to ensure appropriate continuity, disaster recovery (technology resilience), cyber and crisis response capabilities. The… 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
- Hackensack Meridian Health (Hackensack, NJ)
- …Additional research will include Agency for Healthcare Research and Quality (AHRQ), Recovery Audit Program (RAC) Statement-of-Work (SOW), Office of Inspector ... performs all related internal, concurrent, prospective and retrospective coding audit activities across the Hackensack Meridian Health (HMH) network. Reviews… 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
- 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
- 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
- Stanford Health Care (Palo Alto, CA)
- …program that includes but is not limited to ensuring compliance with Medicare and Medicaid billing regulations, fraud and abuse laws, applicable state laws ... The SHC/SMCH CCO also maintains reporting lines to the Audit , Compliance, and Enterprise Risk Committees of the SHC,...patients and families to focus on health, healing and recovery ._ _You will do this by executing against our… more
- Hackensack Meridian Health (Hackensack, NJ)
- …denials by: I. Peer-to Peer (P2P) Concurrent appeals ii. Written Concurrent appeals iii. Recovery Audit Contractors & levels of appeal iv. Root cause analysis & ... status based on length of stay, level of care requirements and Medicare regulations, and Major Complications or Comorbidities (MCC) / Complications or Comorbidities… more