- MetroPlusHealth (New York, NY)
- …including, but not limited to, New York State Medicaid Managed Care, Medicare , Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, ... accuracy program. The incumbent will optimize pre/post claim editing, auditing, and claim recovery programs that will drive incremental value year over year. The PI… more
- Hackensack Meridian Health (Hackensack, NJ)
- …denials by: I. Peer-to Peer (P2P) Concurrent appealsii. 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
- Emory Healthcare/Emory University (Atlanta, GA)
- …Council. + Primary duties and responsibilities: Participates in external reviews such as Medicare Recovery Audit Program or other third-party audit ... programs and defends Emory Healthcares decisions as appropriate through written appeals as needed. + Conducts complete and accurate retrospective reviews and audits of hospital records to determine if patient class (level of care) was appropriate and… more
- HCA Healthcare (Dallas, TX)
- …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
- CVS Health (Scottsdale, AZ)
- …strategic response development based on in-depth experience regarding specific pharmacy audit , contract, credentialing and financial recovery questions and ... to contract depository retrieval, pharmacy credentialing/recredentialing, pricing/rates, pharmacy audits, post- audit activities and recoveries, and associated state/federal regulations governing… 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
- Bassett Healthcare (Cooperstown, NY)
- …sent 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
- Texas Health Resources (Dallas, TX)
- …with legal requirements and THPG standards. Coordinate external audits such as recovery audit contractors for governmental agencies and/or commercial payer ... of and comply with federal and state laws and regulations including Medicare /Medicaid program requirements. Lead and/or work with appropriate resources to ensure… more
- Molina Healthcare (St. Petersburg, 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
- 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
- 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)
- …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
- Veterans Affairs, Veterans Health Administration (Tacoma, WA)
- …Enter and correct information that has been rejected, when necessary. Ensure audit findings have been corrected and refiled. Use various computer applications to ... to the accuracy of the facility database as well as all cost recovery programs. Assist facility staff with documentation requirements to completely and accurately… more
- Trinity Health (Silver Spring, MD)
- …or downgraded coverage determinations by managed care, commercial payers, and recovery audit contractors. **MINIMUM QUALIFICATIONS** Graduate of an accredited ... with clinical documentation requirements * Working knowledge of Centers for Medicare and Medicaid Services rules and regulations, and interest in building… 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
- Sunnyside Nursing and Post-Acute Care (Torrance, 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
- 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
- St. Luke's University Health Network (Allentown, PA)
- …against milestones, resolve discrepancies, and collaborate with finance teams to maintain audit -ready records and ensure alignment with study budgets and contracts + ... of funds, compliance with sponsor agreements, and optimization of cost recovery . This includes managing indirect cost allocations, applying appropriate fee structure… more
