- Highmark Health (Columbus, OH)
- …supervisory direction and oversight for all enrollment, premium billing, claims and/or customer service telephone and written correspondence inquiries (routine, ... training and mentor programs, and assists to provide interview/hiring and audit support when needed. **ESSENTIAL RESPONSIBILITIES** + Supervises the daily operations… more
- Highmark Health (Columbus, OH)
- …OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and ... identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external … more
- OhioHealth (Columbus, OH)
- …quality, productivity, coder training/education, physician onboarding/education and failed claims for the OhioHealth Network and OhioHealth Physician Enterprise. ... responsible for supporting Central Billing Office as necessary regarding Claims Processing issues as it relates to coding. This...for OPG practices. 15% 4. Monitors coder & physician audit results to maintain quality of information at all… more
- Highmark Health (Columbus, OH)
- …for proactive and investigative purposes to comply with internal audit and regulatory requirements. **ESSENTIAL RESPONSIBILITIES** + Performs investigations into ... Credentialing or Medical Review Committee. + Engages in delivery of audit results and overpayment negotiations.Responsible for recovery/ savings of misappropriated… more
- Belcan (Mason, OH)
- …performance metrics. Responsible for setting up and maintaining clients in the claims processing system. Additional duties: Supporting the Plan Setup team by ... for setting up new Managed Care groups in the claims system * Responsible for fulfilling requested revisions to...configuration requests) * Follow the established corporate and industry audit controls (ie SOX, SSAE 18, etc.) Specific Skills… more
- Molina Healthcare (Cleveland, OH)
- …you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and quality functions. You surface systemic issues, steer partners ... durable fixes, and convert disciplined CTM management into Stars gains, audit readiness, and measurable member-experience improvements. You'll begin as a senior… more
- Banner Health (OH)
- …information from a variety of sources. 2. Reviews medical records. Performs an audit of clinical documentation to ensure that clinical coding is accurate for proper ... to resolve issues and support appropriate reimbursement. Proficiency in claims software to address coding edits and claim denials...as a basis for development of coding education and audit plans. 6. Maintains a current knowledge in all… more
- Walmart (Wintersville, OH)
- …evaluating air water and waste pollution Supports regulatory visits and prepares audit reports for management review Participates in evaluating pollution control and ... for accidents Reports safety violations and accidents Implements internal and external audit requirements within assigned area of work Creates action plans to… more
- Prime Therapeutics (Columbus, OH)
- …Program Integrity Audits including outreach and review of medical records to audit authenticity of provider response during Prior Authorization and reporting results ... + Available for consultation in pharmacy related questions to resolve claims submission related to medication edits. + Contacts physicians/prescribers to obtain… more
- Otsuka America Pharmaceutical Inc. (Columbus, OH)
- …optimization, continuous improvement and governance to areas such as training and audit . Foster a culture of operational excellence, ensuring best practices are ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more