- Elevance Health (Columbus, OH)
- ** Audit & Reimbursement Senior ** _Location:_ This role enables associates to work virtually full-time, with the exception of required in-person training ... and Medicaid Services to transform federal health programs._ The ** Audit and Reimbursement Senior ** will...report reopenings. + Manage caseload of Medicare cost report Appeals + Position papers + Jurisdictional Reviews + PRRB… more
- Trinity Health (Columbus, OH)
- …a wide variety of professional roles including information technology, financial analysis, audit , provider relations and more. **Position Purpose:** The Appeals ... and Grievance Coordinator is responsible for the processing and resolution of appeals , grievances and disputes from members and providers **What You Will Do:** +… more
- LA Care Health Plan (Los Angeles, CA)
- Senior Health Care Audit Analyst Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... The Specialty Plans Auditor III is responsible for planning audits and audit work programs that address appropriate claims and financial compliance criteria for… more
- Independent Health (Buffalo, NY)
- …correlating coding complexity. They will aid in training other team members, evaluating appeals , and share audit trends across the team. Expertise and ... tips across the team. The Clinical & Coding Specialist- Senior will support the leadership in Hospital Audit...to prepare quantitative and qualitative studies at conclusion of audit . Ability to recalculate reimbursement following conclusion… more
- Trinity Health (Des Moines, IA)
- …identifies and manages all financial and compliance risk associated with the reimbursement function, keeping senior leadership apprised of identified risk and ... reimbursement function (for acute and professional services), notifying senior leadership of identified risks and tracking and monitoring...party audits and takes a lead role in resolving audit issues and developing appeals . Directs the… more
- UPMC (Pittsburgh, PA)
- …third-party cost reports and assist reimbursement teams across UPMC facilities. + ** Audit Defense & Appeals :** Review audit adjustments, prepare ... drive impactful decisions? UPMC Corporate Finance is seeking a ** Senior Reimbursement Analyst** to join our dynamic...of cost report tools and maintain version backups for audit and appeal readiness. + **Ensure Financial Integrity:** Analyze… more
- CommonSpirit Health (Phoenix, AZ)
- **Responsibilities** **Position Summary:** The Senior Reimbursement Analyst is responsible for providing cost report preparation cost report appeals audit ... also assists in the improvement of internal business processes and meeting future reimbursement service needs. The Senior Reimbursement Analyst carries out… more
- CommonSpirit Health (Phoenix, AZ)
- **Responsibilities** The ** Senior Reimbursement Analyst i** s responsible for providing cost report preparation, cost report appeals , audit preparation ... also assists in the improvement of internal business processes and meeting future reimbursement service needs. The Senior Reimbursement Analyst carries out… more
- New York State Civil Service (Albany, NY)
- NY HELP Yes Agency People With Developmental Disabilities, Office for Title Senior Attorney Occupational Category Legal Salary Grade 25 Bargaining Unit PS&T - ... and conditions. * Review and analyze issues raised in bid protests and appeals of agency level bid protest determinations. Prepare bid protest determinations. *… more
- Cardinal Health (Charleston, WV)
- …go. **Accountabilities** The Case Manager supports patient access to therapy through Reimbursement Support Services in accordance with the program business rules and ... for every interaction using the appropriate database for the inquiry + Must self- audit intake activities to ensure accuracy and efficiency for the program + Make… more
- CHS (Clearwater, FL)
- …One core service, claims administration, is where submissions for payment/ reimbursement /sharing from medical providers and covered individuals are reviewed, subject ... as transparency in reporting results, trends and issues to Senior Management and clients. * Management of relationships with...Examiner queues waiting to be adjudicated, and in either audit or needing approval status. * Developing and implementing… more
- Presbyterian Homes and Services (Roseville, MN)
- …resident's stay. + Audit RUG grouper/MDS end splits, review all expedited appeals and ALJ level appeals . Perform concurrent MDS review to assure appropriate ... working knowledge of the RAI process + Experience with MDS completion, reimbursement , clinical resource utilization and/or case management + Ability to work flexible… more
- Somatus (Mclean, VA)
- …Paid Time Off (PTO) + Professional Development, CEU, and Tuition Reimbursement + Curated Wellness Benefits supporting teammates physical and mental well-being ... Need Plans (SNPs). The Director, Quality will work closely with Sr. Manager, Audit Risk and the Regulatory and Accreditation Team to ensure compliance with audits,… more
- St. James Hospital (Hornell, NY)
- …to assure the completion of the private, Medicare, and all other financial-related audit activities. + Coordinates the operations of the Audit Committees of ... Foundation. + In collaboration with URMC Payer Contracting and Reimbursement department, negotiates payment/contract agreements with third-party payers and assures… more
- LA Care Health Plan (Los Angeles, CA)
- …setting. Experience in health care auditing and monitoring (preferably in Appeals , Grievances, Quality Improvement, Utilization Management (UM) and so forth) and ... developing audit tools. Demonstrated experience developing and delivering training programs...to state/federal sanctions and fines- communicate required action to senior management/Board of Governor (BoG), Plan Partner staff. 2.… more
- Toyota (Plano, TX)
- …in a large to medium-sized corporate tax department. + Public accounting audit /tax experience and public accounting tax senior manager level experience, ... and Finance Division is looking for a highly motivated and qualified Senior Manager - International Tax Planning. The primary responsibility of this "Director… more
- BrightSpring Health Services (Louisville, KY)
- …those related to risk adjustment, STARS quality ratings, encounter data submission, and audit readiness. + Monitor changes in federal and state policy affecting MA ... responsible leadership in healthcare operations, with at least 5 years in a senior executive role within a Medicare Advantage or related managed care environment. +… more
- LifePoint Health (Richlands, VA)
- …Program - mental, physical, and financial wellness assistance * Tuition Reimbursement /Assistance for qualified applicants * Employee discount program * And much ... the Operations Team, provides quality data as available to Senior Management. * Provides data for analysis, in the...on the Corporate Portal * Acts as facility Recovery Audit Coordinator. Ensures completion within the regulated time frame… more