- Medical Mutual of Ohio (OH)
- …business (Commercial, Marketplace, Medicare Advantage, and Medicaid), including HEDIS audit submission, Consumer Assessment of Healthcare Providers and Systems ... + Ability to utilize certified HEDIS software. + Ability to analyze clinical, claims , pharmacy, encounter, and quality measurement data. + Advanced knowledge of NCQA… more
- Molina Healthcare (Cincinnati, OH)
- …of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of ... the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program experience as… more
- OhioHealth (Columbus, OH)
- …and revenue cycle. Work with Patient Financial Services to manage the denied claims list for any potential errors and resubmissions. Facilitate CMS compliance and ... 10% Compliance Review research-related transactions for compliance. Assume responsibility for audit preparedness activities for OHRI RBS. Auditing patient records in… more
- Aston Carter (Columbus, OH)
- …overseeing critical activities like accounting administration, cost reporting, and audit participation. Responsibilities + Ensure compliance with Mechanics Lien Act, ... performance metrics. + Guide the team in preparing LEMs, invoices, and progress claims , ensuring adherence to approval processes and contract terms. + Provide timely… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... in response to approved change requests; retain old and new report design for audit trail purposes. + Analyze data sets and trends for anomalies, outliers, trend… more
- Walgreens (Cincinnati, OH)
- …Quality Improvement Program. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment rejections. Follows-up with ... companies as well as medical providers and conducts or participates in 3rd party audit . + Assists and supports Store Manager and Pharmacy Manager in analyzing and… more
- Cleveland Clinic (Independence, OH)
- …regulations, and identifying revenue cycle compliance risks-such as potential False Claims Act exposures-to protect the organization. This role offers professional ... analyzing areas of risk. + Coordinate responses to monitoring and audit activities. + Distribute material from resources with relevant compliance-related… more
- Cardinal Health (Columbus, OH)
- …notations for every interaction using the appropriate database for the inquiry * Self- audit intake activities to ensure accuracy and efficiency for the program * ... a background in healthcare (such as medical assistant, working in medical claims /billing, pharmacy technician, clinician in a doctor's office, etc) or with insurance… more
- CVS Health (Columbus, OH)
- …regulatory guidelines. + Owns responsibility for supporting targeted quality audit projects, reporting overall results, and making recommendations regarding training ... of problem solving and decision making skills + College degree preferred + Claims experience + DG experience **Education** + High School Diploma or equivalent GED… more
- Aston Carter (Columbus, OH)
- …overseeing critical activities like accounting administration, cost reporting, and audit participation. Your ability to lead, train, and provide performance ... performance metrics * Guide the team in preparing LEMs, invoices, and progress claims , ensuring adherence to approval processes and contract terms * Provide timely… more