- CenCal Health (Santa Barbara, CA)
- …with Directors and Management level staff, this position directs and conducts audit activities of varying complexity and supports initiatives of moderate to complex ... departments and external partners to ensure compliance with Medi-Cal and Medicare regulatory and contractual requirements, and operational plan requirements, as well… more
- CBIZ, Inc. (Tallahassee, FL)
- …leading audit engagements Demonstrated high level of expertise with Medicare and Medicaid regulations Strong analytical and problem solving skills Strong verbal ... health and human services reimbursement consulting firm, specializing in audit , accounting, data management and consulting services to government-sponsored health… more
- PacificSource (Portland, OR)
- …levels of member satisfaction and quality performance, access, compliance and audit readiness, and sound financial performance. Develop and monitor departmental ... budgets. Oversee Medicare Advantage and Medicaid operations to ensure regulatory compliance...the drafting and documentation of internal controls and reporting, Medicare Advantage and Medicaid policies and procedures, keeping all… more
- Ensemble Health Partners, Inc. (Green Bay, WI)
- …accounts and assures that all forms are completed accurate, timely to meet audit standards and provides statistical data to Patient Access leadership. Patient Access ... and distributes patient education documents, such as Important Message from Medicare , Important Message from Tricare, Observation Forms, MOON form, Consent forms,… more
- Ensemble Health Partners, Inc. (Richmond, VA)
- …accounts and assures that all forms are completed accurate, timely to meet audit standards and provides statistical data to Patient Access Leadership. Senior Patient ... Explains and distributes patient education documents, such as Important Message from Medicare , Observation Forms, Consent forms, and all forms implemented for future… more
- Guardian Pharmacy, LLC (Marietta, GA)
- …updates patient/insurance information into billing system. Maintain and continually audit patient files and corresponding documentation necessary to defend third ... Provide guidance and support to resident or responsible party by running Medicare plan comparisons during open enrollment and special enrollment periods. Proactively… more
- Beacon Health System (Granger, IN)
- …support Beacon Managed Care including Accountable Care Organizations (ACO) and Medicare Shared Savings Programs (MSSP) and HealtheIntent by delivering standardized ... of Beacon Managed Care including Accountable Care Organizations (ACO) and Medicare Shared Savings Programs (MSSP) and HealtheIntent. Documents deliverables created,… more
- UHS (Riverside, CA)
- …in areas such as - routine reporting, ad hoc reporting, annual oversight audit preparation, annual audit oversight completion, response to CAPs, and follow-up ... to ensure compliance with Federal and State laws and regulations (Centers for Medicare and Medicaid Services, Department of Managed Health Care, Department of Health… more
- CenCal Health (Santa Barbara, CA)
- …those related to NCQA certification and implementation of the Medicare D-SNP line of business Qualifications Knowledge/Skills/Abilities Required: In-depth knowledge ... knowledge of the healthcare, economic or other issues affecting Medi-Cal and/or Medicare populations, providers and the underserved in Santa Barbara and San Luis… more
- 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, ... the healthcare or insurance industry Extensive knowledge of health care provider audit methods and provider payment methods, clinical aspects of patient care,… more
- University of California San Francisco (San Francisco, CA)
- …coordinate and prepare for sponsor or collaborator visits such as site initiation, audit and monitor visits; interface with departments to assist with obtaining UCSF ... with timely processing of new protocols through the activation pipeline including Medicare coverage analysis and budget sign off, informed consent approval and IRB… more
- Tennr (New York, NY)
- …standards. This role will own policy development, internal controls, training, and audit readiness across the business. You'll partner closely with Legal, Security, ... to design and maintain internal controls, policy documentation, and audit readiness programs. Experience running cross-functional compliance initiatives, including… more
- UHS (Riverside, CA)
- …of decisions, initial notifications, and written notifications following the Centers for Medicare and Medicaid Services (CMS), the Department of Health Care Services ... the Utilization Management (UM) program and processes and ensures timely audit submissions for UM, Claims, Credentialing, and other delegated functions. Collaborates… more
- Walmart, Inc. (Orlando, FL)
- …inventory (pharmaceuticals, supplies). Ensure adherence to inventory control procedures, audit pill cell performance, conduct process audits, manage databases, ... documentation, and ensure a safe and clean work environment. Comply with Medicare and Medicaid policies by implementing rules and regulations, keeping up-to-date on… more
- CareRing Health, LLC (Philadelphia, PA)
- …primary care, homecare, and hospice care - to the chronically-ill, Medicaid/ Medicare -eligible population. Our innovative healthcare delivery model will result in ... compliance breaches and exposures. Developing, implementing, and maintaining internal audit policies and procedures in accordance with local and international… more
- Southern Oaks Care Center (Pawnee, OK)
- …pre-certifications and recertifications in accordance with facility policies for Medicare Advantage and commercial insurance payers. Interpret the department's ... facility surveys (inspections) made by authorized government agencies as requested. Audit nursing documentation in the clinical record for appropriate and relevant… more
- Sevita (Minneapolis, MN)
- …Ensure internal control compliance with all assigned areas and other audit requirements Maintain an effective control environment for the accounting operations ... and HCFA-1500 forms Strong understanding of medical collections compliance, Medicare , Medicaid, Medicaid managed care, Commercial, Workers Comp, and Auto-no-fault… more
- Duke Health (Durham, NC)
- …and all other required patient record documentation. Return medical records. Attach HIPPA/ Medicare documents to the encounter forms. Check-in patient upon arrival in ... Prepare encounter forms. Investigate and account for missing encounter forms. Audit encounter forms for completeness and accuracy before batching. Batches encounter… more
- Livingston County, NY (Geneseo, NY)
- …agencies; Oversees the third party billing to health insurance providers, Medicare , and Medicaid; Devises procedures to ensure maximum third party reimbursement; ... 2.0. Accounting is a higher level than a bookkeeping position, an account/ audit clerical position, an accounts receivable position, or an accounts payable position.… more
- APLA Health (Los Angeles, CA)
- …in the PayCom system. Perform weekly medical chart audits (per the chart audit tool) to ensure that demographic information is correctly entered in patient charts; ... and CPT coding Healthcare billing processes and insurance plans (Medicaid, Medicare , and private/commercial plans; including dental and/or mental health preferred)… more
