- St. Luke's Health System (Boise, ID)
- …Resolve payor audit records requests + Track and coordinate resolution of Medicare Recovery Audit Contractor ( RAC ) audits with Corporate Compliance + ... a great place to work. **What You Can Expect:** The Billing and Recovery Audit Specialist is responsible for supporting various aspects of the Revenue Cycle,… 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
- 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
- Hospice of Michigan (Ann Arbor, 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
- 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
- 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
- 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
- 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
- Trinity Health (Langhorne, PA)
- …Maintains database of duplicate and overlay corrections for reporting purposes 11. Assists with RAC and other audit activity by entering needed data to track ... 4. Selects appropriate or defined sample size to support audit validity 5. As directed, performs audit ...support audit validity 5. As directed, performs audit of metadata to detect potential privacy breeches related… 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
- 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
- Parexel (Nashville, TN)
- …with global functions to obtain documentation aligned with local requirements. Audit & Inspection Support * Support RA representatives during audits/inspections, ... in law, legal affairs, or natural sciences. * Regional Regulatory Affairs Certification ( RAC , CARP, CHPC) is a plus. Experience * 3-5+ years of local regulatory… more
- Community Health Systems (Franklin, TN)
- …requirements related to denials and appeals. + Processes BARRT requests, reviews RAC /Government Audit accounts, and completes necessary rebills and adjustments. ... + Identifies trends in denials to suggest improvements and reduce future claim issues, providing data for denial and appeal trends as needed. + Performs other duties as assigned. + Maintains regular and reliable attendance. + Complies with all policies and… more
- Capgemini (New York, NY)
- …dataset remediation. + **Inspection Preparedness** : FDA/EMA mock inspections, audit readiness, corrective/preventive actions. + **Health Authority Engagement** : ... + Experience across **emerging biotechs** and **large pharma** portfolios. + ** RAC preferred** ; advanced degree (PharmD/PhD/MS/MD). + Strong consulting toolkit:… more
- University of Colorado (Aurora, CO)
- …controls and fiduciary stewardship to determine areas vulnerable from an audit perspective and develop plans, recommendations, policies, and procedures to strengthen ... as a Clinical Research Professional (CCRP) + Regulatory Affairs Certification ( RAC ) for drugs and devices + Prior experience managing investigator initiated… more
- Virginia Mason Franciscan Health (Burien, WA)
- …Focus on concurrent medical necessity denials * Participate in audits by CMS, RAC entities, or other agents as required * Participate in the utilization ... and report on PEPPER metrics; (LOS, CMI, Re-admissions, OBS rates, and governmental audit measures) to Hospital leadership * Support and/or perform the ALJ and DAB… more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- …make referrals for identified continued care needs. Additionally, you will support chart audit functions including RAC and third-party requests, and assist in ... identifying department interventions and priority expectations to improve case management metrics such as length of stay reduction, readmission reduction, and discharge times. As a valued team member, you will practice autonomously, consistent with practice… more
- Robert Half Technology (Washington, DC)
- …Manage user accounts, roles, and permissions to maintain data security. + Audit database activities and maintain compliance with security standards. + Document ... Oracle database administration. + Expertise in Azure Managed Instance, AWS RDS, Oracle RAC , RMAN backups, and Oracle Data Guard. + Knowledge of database security… more