- Humana (Raleigh, NC)
- …participation in hearings involving an Administrative Law Judge, support for CMS audits, cross-functional team activities, and other responsibilities as determined ... and work is assisted by diverse resources, included but not limited to CMS policies, National and Local Coverage Determinations, CMS -recognized Compendia, NCCN,… more
- Humana (Raleigh, NC)
- …you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus on our 5+ ... To succeed in this position, you will need to be well versed in CMS knowledge of outpatient, inpatient and appeal criteria including regulation and policies. You… more
- UNC Health Care (Morrisville, NC)
- …we serve. **Summary** The Project Manager will utilize a learned knowledge of CMS policy and regulatory program requirements to develop and manage actions which ... drive optimal Merit-Based Incentive Payment System (MIPS) performance. This position leads and collaborates on...(MIPS) performance. This position leads and collaborates on annual CMS regulatory program methodologies and updates, as well as… more
- Highmark Health (Raleigh, NC)
- …Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, state, CMS ... departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes...not limited to NIST, HITRUST, PCI, HIPAA, SOC, MAR, CMS , JCAHO, in order to identify, assess, prioritize, evaluate… more
- Cardinal Health (Raleigh, NC)
- …findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories and healthcare ... communication of audit results to physicians, physician leadership, senior leadership, management , and staff; physician and coder education; and the making of… more
- UNC Health Care (Chapel Hill, NC)
- …the unique communities we serve. Summary: Responsible for assisting Compliance management in all compliance activities which could include reviewing internal ... and other standards such as CPT coding guidelines and CMS policies. Assists in preparing annual audit and work...of audit findings to department leadership as directed by management . Seeks out and analyzes opportunities to improve and… more
- Elevance Health (Durham, NC)
- …data quality management processes and procedures. + Provide support for CMS audits and other regulatory reporting requirements. + Develop and analyze business ... is responsible for analyzing and validating healthcare encounter data submissions to CMS (Centers for Medicare & Medicaid Services). This role involves ensuring the… more
- Humana (Raleigh, NC)
- …help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual ... by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.… more
- CVS Health (Raleigh, NC)
- …codes that are submitted to the Centers for Medicare and Medicaid Services ( CMS ) for the purpose of risk adjustment processes are appropriate, accurate, and ... process audits to ensure compliance with internal policies and procedures and existing CMS regulations. + Ability to work independently as well as in a cross… more
- Elevance Health (Durham, NC)
- …position is part of our NGS (National Government Services) division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of ... : + Degree in Accounting preferred. + Knowledge of CMS program regulations and cost report format preferred. +...regulations and cost report format preferred. + Knowledge of CMS computer systems and Microsoft Office Word and Excel… more