- HCA Healthcare (Brentwood, TN)
- …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
- 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 ... **to login and apply.** Full Time Job Summary: The Senior Internal Audit Analyst plays a critical role in evaluating and improving the effectiveness… more
- Avera (Sioux Falls, SD)
- …specific audit activities, including support for outside agencies such as Recovery Audit Contractors (RAC), Medicare Administrative Contractors (MAC), ... and/or post bill encounters. + Develops reports and/or education based on quality audit findings or requested risk areas and evaluates clinicians' and coder coding… more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... for Fallon Health government and state sponsored products including Medicare Advantage, Commercial/ACA, PACE, and Medicaid. **Responsibilities** **Primary Job… more
- Molina Healthcare (Dayton, OH)
- …solutions. + Manages Scorable Action Items (SAIs) related to pre-pay editing, post-pay audit , and overpayment recovery initiatives to ensure Health Plan SAI ... Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay… 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
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …activities + Collaborate with other departments such as Claims, Medical Management, Internal Audit , Recovery and Legal teams + Support litigation and legal ... AHCA, and other regulators and authorities + Perform monthly audit for excluded/precluded providers + Develop CMS HPMS and...+ Minimum of 5 years of FWA, healthcare and/or Medicare Advantage experience + Strong knowledge of Medicare… more
- Bassett Healthcare (Sherburne, 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
- Stony Brook University (Stony Brook, NY)
- …back-up supervisory, phlebotomy, quality assurance, send-out testing processing and billing audit duties under the supervision of the Specimen Receiving and ... * (ii) Directs Specimen Receiving Department staff during LIS/SMS/Cerner downtime and recovery . Coordinates manual delivery of lab test results to units. Resolves… 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
- Baylor Scott & White Health (Phoenix, AZ)
- …on appealing hospital and professional clinical and coding denials, as well as Recovery Audit Contractors (RAC) denials. This role will be responsible for ... senior leadership, and senior medical staff including denials from all payers, Medicare /Medicaid audit activities and key contract enforcement activities. +… more
- Molina Healthcare (Nampa, ID)
- …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
- The County of Los Angeles (Los Angeles, CA)
- …and procedures concerning administration, ensuring compliance with Federal and State Medicare and Medicaid regulations for reimbursement claiming and maximum ... recovery costs for directly billable services. + Develops and...as necessary. + Oversees audits and the implementation of audit recommendations for programs managed. + Represents managed programs… 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
- 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
- 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 ... billing rates to reflect cost changes and maximize cost recovery . + Analyzes utilization of billing rates and/or contract...manuals pertinent to accounting control, fiscal record keeping and audit trails. + Reviews, analyzes and drafts replies to… 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
- Softheon (Atlanta, GA)
- …frameworks that align with healthcare regulations (HIPAA, HITRUST, CMS, ACA, Medicare , Medicaid, PCI-DSS, SOC, NIST, MARS-E, and others). + Maintain oversight ... + 10+ years of progressively responsible experience in governance, risk, compliance, and audit leadership, ideally within healthcare or health tech. + 7+ years of… 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
- 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