- Datavant (Columbus, OH)
- …company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right ... team. Together, we're rising to the challenge of tackling some of healthcare 's most complex problems with technology-forward solutions. Datavanters bring a diversity… more
- Molina Healthcare (Columbus, OH)
- …Responsible for conducting various audits including, but not limited to; vendor, focal, audit the auditor. Confirm that documentation is clear and concise to ensure ... schedules, and other business requirements critical to claim accuracy. Maintain audit records, and provide counsel regarding coverage amount and benefit… more
- Molina Healthcare (Columbus, OH)
- …order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with ... data analysis, and makes determinations as to whether the investigation and/or audit identified potential fraud, waste, or abuse. + Coordinates with various internal… more
- Molina Healthcare (Columbus, OH)
- …contributing to the end-to-end data strategy and execution of CMS and internal audit activities. This position is responsible for supporting RADV audit cycles ... support regulatory and clinical compliance. **Knowledge/Skills/Abilities** + Support RADV audit execution by identifying appropriate data sources, validating CMS … more
- Molina Healthcare (Cincinnati, OH)
- …and adherence to applicable timelines * Support all risk adjustment audit related projects to ensure goals, objectives, milestones and deliverables are ... met * Evaluate results from audit activities to address barriers, gaps, opportunities for improvement,...position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina… more
- Molina Healthcare (OH)
- …COB and TPL processing logic. + Assist in developing and refining internal SOPs and audit tools related to COB claim reviews. + Act as subject matter expert for ... + Assists manager in establishing standards, guidelines, and best practices for the audit team + Interprets and validates accuracy of complex reports and automated… more
- Molina Healthcare (Cleveland, OH)
- …while collaborating with other teams. * Ensure compliance with all regulatory audit guidelines by adhering to roadmap of deliverables and timelines and implementing ... solutions to maximize national HEDIS audit success. * Partner with other teams to ensure...running queries in Microsoft Azure or SQL server * Healthcare experience and functional risk adjustment and/or quality knowledge… more
- Molina Healthcare (Cleveland, OH)
- …with national and state delegates. + Coordinates, evaluates, and reviews delegation audit assessment tools as necessary to comply with state, federal, NCQA, and ... Compliance Committees as applicable. + Manages department processes to monitor the audit and monitoring performance of delegated entities on a regular interval and… more
- Molina Healthcare (Dayton, OH)
- …to meet compliance requirements. + Act as a liaison between IT, business, audit , and compliance teams to align IAM initiatives with organizational needs. + ... support business objectives. + Generate and analyze identity lifecycle KPIs and audit results to identify areas for improvement. + Train business stakeholders on… more
- Molina Healthcare (Dayton, OH)
- **Job Description** **Job Summary** Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and ... and other performance indicators. * Ensures completion of staff quality audit reviews. Evaluates services provided and outcomes achieved and recommends… more