- HCA Healthcare (Nashville, TN)
- …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
- State of Colorado (Denver, CO)
- …Provider Payment Reviews + Fraud Investigation + Waste and abuse reviews and recoveries + Recovery Audit Contract ( RAC ) + Data analytics and data mining for ... Investigation + Waste and abuse reviews and recoveries + Recovery Audit Contract ( RAC ) +...describe your experience working with FWA vendors, for example, RAC vendors. What kind of contractor oversight… more
- Ochsner Health (New Orleans, LA)
- …in a data-driven approach + Facilitate pre-payment reviews and/or participating in recovery audit contractor reviews + Assist Hospital Administration ... in appeals process for retrospective denials + Assist Hospital Administration and the Medical Staff in connection with any regulatory audits, investigation, survey, or other review of the Departments + Ensure consistency of utilization review services, quality… more
- Catholic Health Initiatives (Omaha, NE)
- …in a data-driven approach + Facilitate pre-payment reviews and/or participating in recovery audit contractor reviews + Assist Hospital Administration ... in billing for the technical component of the services rendered by the Departments, including initial billings, follow-up reports, and appeals in cases of retrospective denials + Assist Hospital Administration and the Medical Staff in connection with any… more
- Mohawk Valley Health System (New Hartford, NY)
- …internal and external compliance audits for the Mohawk Valley Health System ("MVHS") audit and compliance function under the guidance and direction of the Chief ... + Develop and deliver compliance training based on identified audit findings. + Prepare detailed audit reports...and compile statistical analysis. + Serves as the primary RAC and appeals liaison for the hospital, including preparation… more
- LifePoint Health (Rutherfordton, NC)
- …discharge plans.5. Follows up with any denials through the appeals process; including RAC chart audit reviews. Emergency Department (ED) Case Management1. Serves ... and assure documentation meets Medicare requirements to reduce the risk related to RAC 's.5. Documentation in the medical records is completed in the appropriate time… more
- Highmark Health (Oklahoma City, OK)
- …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
- St. Luke's University Health Network (Allentown, PA)
- …leadership team. Oversees account changes pertaining to accepted and/or appealed audit recommendations and works with staff assisting with clerical and ... administrative tasks related the appeals/ audit function. Identify and provide feedback, including identification of...advisor in review of patient medical records identified by RAC /MIC/QIO and other insurers or outside auditors in retrospective… more
- Herbalife (Winston Salem, NC)
- …tools - Kubernetes, Terraform, Git, Dynatrace, Splunk * Configure monitor and audit with Dynatrace and Splunk * Develop mechanisms to consume and filter ... audit , ksql process log topics * Define and monitor...- Oracle Middleware/Fusion (SOA Suite) - Oracle Database and RAC WHAT'S SPECIAL ABOUT THE TEAM: Database and Integration… 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 discharge and care progression. + Perform concurrent review of cases greater than 4 days or the assigned/estimated GMLOS + Partner with the care management team with the management of LOS, complex care needs and patient throughput efforts. Provide… more
- Wolters Kluwer (Chicago, IL)
- …Important responsibilities include cross-functional correspondence, quality management reviews, audit support, change planning, and corrective and preventative ... future issues . Lead Auditor Certified, preferred . Regulatory Affairs Certification ( RAC ), preferred. **TRAVEL:** Travel is minimal and tends to be irregular in… 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 ... credential(s), such as: GFSI recognized auditor credential; CQA, RABQSA, IRCA, RAC , Pharmaceutical GMP Professional Certification (CPGP) + Four years related work… more
- LifePoint Health (Richlands, VA)
- …of Disclosures. * Reports breaches on the Corporate Portal * Acts as facility Recovery Audit Coordinator. Ensures completion within the regulated time frame by ... CMS and the RAC reviewers. Coordinates all files, response letters and files appropriate appeals, necessary in collaboration with Case Management and the physicians.… more
- Mohawk Valley Health System (Utica, NY)
- …procedure codes, for accurate and timely billing of most appropriate payer + Audit charges and establish proper coding in collaboration with providers + Initiate and ... departments with diagnostic and procedural coding + Respond to Insurance, compliance and RAC denials + Review and assist in the maintenance of coding related… more
- Stryker (Portage, MI)
- …high team engagement + Participates in advocacy activities of a technical audit /nature **What you need:** Required: + Bachelor's degree required. Preferred degree in ... field. + 6+ years of regulatory experience. Preferred: + Master's Degree or RAC preferred + Previous supervisory experience preferred + Experience with Class III… more
- UNC Health Care (Rocky Mount, NC)
- …Revenue Integrity/Regulatory Services, Document Management, Chart Correction, Forms Management and RAC / Audit . Provides direction and leadership to assure support ... and accomplishment of the health system's health information management functions, through well-organized, efficient, and effective processes. Responsible for ensuring compliance with state and JCHAO regulations. 2. Leading People - Leads people toward meeting… more
- The US Pharmacopeial Convention (USP) (Rockville, MD)
- …to cGMP requirements and proficiency with regulation and guideline interpretation, audit procedures, proper documentation, and quality assurance. * Experience with ... Regulatory Affairs Professional Society (RAPS) as a Regulatory Affairs Certified ( RAC ) professional. * Working knowledge of the International Conference on… more
- Prime Healthcare (Ontario, CA)
- …over quarter improvement in CMS Value Based Purchasing Program.9 Serves as the Assistant RAC Coordinator in consultation with HIM Director and PHS Revenue Audit ... team.10. Establishes and implements a mechanism for ongoing communication with nursing/patient care staff and conducts senior rounding with staff and patients/families on a routine basis.11. Performs all other duties as assigned or required. #LI-CC1… more
- Lockheed Martin (Orlando, FL)
- …of the contract negotiating team and interacting with DCAA and other audit agencies * Initiating process improvements to enhance productivity and efficiency within ... include: \- EPP preparation and presentation \- BOE Development and Generation \- RAC review process \- Proposal strategy and analysis \- Cost volume preparation \-… more
- Nike (Beaverton, OR)
- …databases & meet Operating Level Agreements between internal teams; support of audit and compliance functions; provide engineering expertise for assigned projects & ... occupation. Experience must include: + Oracle 19C/11gR2/10G databases + Oracle 11/10G RAC , ASM + Oracle DataGuard and Golded Gate replication + AWS +… more