- Parexel (Columbia, SC)
- …and 510(j)(3) reporting through nextGen portals is a plus - Ensure audit readiness and version control through meticulous documentation and system management ... in Pharmaceutics, Biochemistry, Molecular Biology, Biotechnology, or Biology preferred - RAC certification is a plus Given the client's location, preference will… more
- Guthrie (Sayre, PA)
- Summary The Denial, Appeal, and Audit Manager is responsible for the oversight and management of all payer denials, appeals, and audit processes within the ... resolution of claim denials, effective appeal strategies, and proactive audit response. The manager leads a team of specialists,... Oversight + Manage payer and third-party audits (eg, RAC , MAC, UPIC, commercial payers) + Coordinate timely record… more
- Beth Israel Lahey Health (Newburyport, MA)
- …direction of the Director of Health Information Management, the Health Information Management Audit Specialist handles various audit requests for the release of ... all the logging and tracking of requests and the audit process from initiation through mailing, in collaboration with...request for specificity in the documentation requested (eg, MAC, RAC , Payor Audits, Compliance Audits) and verifies that the… more
- AdventHealth (Altamonte Springs, FL)
- …from regulatory agencies including, but not limited to, Additional Development Requests (ADRs), Recovery Audit Contractor ( RAC ) requests, Quality ... team:** + Coordinates all phases of record request processing, including ADRs, RAC requests, and Medicaid audits. + Develops and implements procedures and processes… more
- Hospice of Michigan (Southfield, MI)
- …complete responses to Additional Development Requests (ADRs), Comprehensive Error Rate Testing (CERT), Recovery Audit Contractor ( RAC ) etc., requests and ... participates in appeal processes. + Participates in the development and annual revision of Quality Assessment and Improvement Plans and Program Evaluation. + Participates in analyzing, developing, coordinating and implementing plans of correction for noted… more
- HonorHealth (AZ)
- …improvement efforts + Supports compliance related to consistency of technical and professional: Recovery Audit Contractor ( RAC ) reviews. + Performs ... other duties as assigned Education + MD or DO Board Certified Physician with a special interest in Utilization Management & Quality Improvement in - Required + Graduates of an accredited medical school - Required Experience + 5 years of recent experience in… more
- Celestica (Maple Grove, MN)
- …and partners, and ensuring compliance with regulatory requirements (FDA, ISO, ASQ, RAC ). The position is virtual, offering competitive compensation and career growth ... customer surveys, operational reviews, and system applications. * Cultivate an " audit -ready" culture and direct the Global Regulatory Compliance Audit … more
- SAIC (Washington, DC)
- …+ Manage user accounts, roles, and permissions to maintain data security. + Audit database activities and log changes. + Maintain detailed documentation of database ... including VMWare, Azure (IaaS/PaaS), and on-premises. + Experience with Oracle RAC , Oracle Enterprise Manager, RMAN backups, Oracle Data Guard, and setting… more
- Baylor Scott & White Health (Phoenix, AZ)
- …focused on appealing hospital and professional clinical and coding denials, as well as Recovery Audit Contractors ( RAC ) denials. This role will be ... payer denial codes, appeal strategies and regulatory frameworks. + Familiarity with RAC audit processes preferred + Experience collaborating across multiple… more
- Community Health Systems (Franklin, TN)
- …The DRG Denials Auditor conducts hospital inpatient DRG denial audits for both RAC and non- RAC accounts, reviewing patient records for accuracy in ICD-10-CM/PCS ... to payers with a strong attention to detail. Additionally, the auditor provides audit feedback to relevant parties, including coders and coding managers, to improve… more
- BD (Becton, Dickinson and Company) (San Diego, CA)
- …insight/guidance during CDx / Pharma partner cross-functional meetings + Provides audit support as needed. + Leads implementation of department procedures and ... the Drug and Device Development and Commercialization process. + RAC Certification is a plus. + Good understanding of...the Drug and Device Development and Commercialization process. + RAC Certification is a plus. + Flow cytometry experience… more
- Highmark Health (Harrisburg, PA)
- …entities in response to external coding audits conducted by the Medicare Administrative Contractor , the RAC , MIC, ZPIC, etc. Determine appeal action, prepare ... OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and… 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
- UL, LLC (Allentown, PA)
- …+ Assess and report in accordance with UL, industry scheme, and client audit protocols on facilities working and/or operational conditions as it relates to ... Nutritional Supplements: 21CFR111 + Medical/Homecare Devices: 21CFR820 + Cosmetics: ISO22716 + Complete audit agendas within 14 calendar days of the audit +… more
- Houston Methodist (Katy, TX)
- …ethical and legal business practices and accreditation/regulatory/ government regulations. + ** Audit Oversight & Lifecycle Management** + Lead the management and ... response process for a variety of audits including RAC , MAC, CERT, PERM, TPE, and commercial payer audits....quality review, and timely submission. + Track and analyze audit trends, denials, and appeal outcomes to identify risks… more
- St. Luke's University Health Network (Allentown, PA)
- …and procedure code assignment and MS-DRG/APR-DRG accuracy based on denials or audit findings from government and commercial payers. Meet or exceed established ... the physician advisor in review of patient medical records identified by RAC /MIC/QIO and other governmental or commercial payor auditors in retrospective reviews for… more
- Sharp HealthCare (San Diego, CA)
- …is responsible for the administration of the Sharp HealthCare's (SHC's) compliance audit program. The position provides oversight and maintenance of a high-quality, ... effective, best practices coding, billing, and reimbursement audit compliance program to prevent and detect violations of...risk analyzer software, OIG Work plan, CMS, PEPPER Reports, RAC Denials, industry experts, etc. + Policy and Procedure… more
- Lilly (Indianapolis, IN)
- …-Develop auditing strategy utilizing a risk-based approach -Develop and communicate audit schedule -Lead/Conduct audits -Create audit reports -Review ... Preferences: -Auditor certification (ASQ CQA) and/or Regulatory Affairs Certification ( RAC , RAPS) -Experience with Microsoft Applications, SAP, Veeva, and TrackWise… more
- University of Pennsylvania (Philadelphia, PA)
- …templates). This individual communicates independently at all levels and ensures audit /inspection readiness of assigned projects. The Regulatory Affairs Specialist C ... templates). This individual communicates independently at all levels and ensures audit /inspection readiness of assigned projects. The Regulatory Affairs Specialist C… more
- University of Pennsylvania (Philadelphia, PA)
- …to senior leadership department-wide trial characteristics, accrual information and audit /monitoring findings; such reports will include an assessment of trial ... of clinical trial compliance and quality assurance through communication of audit results and compliance guidelines. + The Associate Director for Regulatory… more
