- HCA Healthcare (Ocala, FL)
- …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
- Dignity Health (Bakersfield, CA)
- …errors. The Recovery Manager works in close coordination with internal audit , provider dispute resolution, and finance to maximize cost recovery , reduce ... or GED + Minimum 5 years of progressive experience in healthcare claims recovery , payment integrity, or post-payment audit functions, preferably within a… more
- Molina Healthcare (Cedar Rapids, IA)
- JOB DESCRIPTION Job Summary Provides support for claims recovery activities including researching claim payment and billing guidelines, audit results, and ... and provider compliance. Collaborates with health plans and vendors to facilitate recovery of outstanding overpayments. Monitors and controls backlog and workflow of… 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 ... assistance is available to support the transition. Job Summary: The Senior Internal Audit Analyst plays a critical role in evaluating and improving the effectiveness… more
- Stanford Health Care (Palo Alto, CA)
- …complete and accurate capture of all legitimate reimbursement opportunities. + Oversee Medicare and Medi-Cal audit processes, addressing inquiries and pursuing ... and regulatory reports to government agencies, including but not limited to: * Medicare and Medi-Cal cost reports *Financial disclosures to the Department of Health… more
- Stanford Health Care (Palo Alto, CA)
- …billing, including federal and state regulations and guidelines, CMS (Centers for Medicare and Medicaid Services) and OIG (Office of Inspector General) compliance ... + Conducts defensive charge audits, self-pay/patient requests, or other special audit projects, as requested, comparing itemized bills to corresponding medical… more
- NHS Management, LLC (Daytona Beach, FL)
- …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
- TEKsystems (Martinez, CA)
- …adjudication, payment integrity, regulatory compliance, and vendor oversight across Medi-Cal, Medicare , and commercial lines of business. This role ensures claims ... responsibility for complex, high-volume systems * Knowledgeable in Medicaid and Medicare : Demonstrates deep understanding of Medi-Cal and Medicare program… more
- Bassett Healthcare (Cooperstown, 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
- Humana (Frankfort, KY)
- …on-prem environments. + Build and maintain L2/L3 SOPs for database operations, backup/ recovery , patching, failover, and disaster recovery . + Oversee change ... Risk teams to continuously assess vulnerabilities, access controls, encryption, and audit readiness. + Define governance standards for data access, retention,… 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)
- …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
- 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
- Morehouse School Of Medicine (Atlanta, GA)
- …Compliance (Operational Execution) * Build/manage study budgets; forecast and monitor cost recovery and margin. * Conduct/review Medicare Coverage Analyses ( MCA ... in trial start-up, site execution, MCA , research billing workflows, and audit readiness from an operations standpoint. * Facility with CTMS /eReg/REDCap; strong… more
- Nuvance Health (Danbury, CT)
- …denied or downgraded coverage determinations by managed care, commercial payers, and recovery audit contractors. * Maintain and Model the organization's values ... with clinical documentation requirements * Working knowledge of Centers for Medicare and Medicaid Services rules and regulations, and interest in building… more
- Banner Health (Tucson, AZ)
- …an innovative leader in health care, Banner Plans & Networks (BPN) integrates Medicare and private health plans to reduce healthcare costs while keeping our members ... help support the Clinical Performance Team in a **temporary assignment** during the annual audit time frame of **January 2026 - June 2026** . You will be requesting… 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
- LifeCenter Northwest (Bellevue, WA)
- …and/or local laws and/or regulations, including those of the Center for Medicare Services (CMS), Uniform Anatomical Gift Act (UAGA), compliance with the Association ... in relation to department performance. + Responsible for on-going departmental audit preparation. + Develops, manages, and leads the departmental budget. Routinely… more
- HCA Healthcare (Webster, TX)
- …budgets. 9. Prepares workpapers to assist Reimbursement staff in filing annual Medicare / Medicaid Cost Reports. 10. Prepares workpapers to facilitate Internal ... Audit staff in their review of internal control procedures...provides nationally-recognized care in the prevention, diagnosis, treatment and recovery of cardiovascular diseases. HCA Houston Healthcare Clear Lake… more