- Molina Healthcare (Covington, KY)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Covington, KY)
- …Access, Word and Excel * Knowledge and understanding of claims processing systems and medical claims * Knowledge of HMO, PPO, POS, MCO, Medicare , Medicaid, ... Market Place products, laws, rules and regulations **Preferred Education** * Master's degree **Preferred Experience** * Formalized training/experience in Health Care Insurance Fraud * Experience with Power BI, SAS, SQL other reporting software * ICD-10 CPT-4,… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …specific to hospital revenue cycle risk areas highlighted by the OIG, Medicare , State Medicaid, State Insurance Fraud; Managed Care or Governmental Value-Based ... risk areas + Assists in auditing and investigations requested by the System Director , Compliance. + Assists in the development of compliance corrective action plans… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …providing critical analytical and reimbursement support for reimbursement functions including Medicare , Medicaid, or other third party cost report, related audits, ... **ADDITIONAL RESPONSIBILITIES:** + Prepares workpapers, reviews and submits annual Medicare and Medicaid cost reports and various other regulatory filings… more