- Intermountain Health (Tallahassee, FL)
- …HIM, PAS, and hospital finance staff as needed. + Prepares monthly Medicare and Medicaid settlement and policy reserve calculations using technically acceptable and ... reimbursement methodologies. + Prepares or reviews cost reports and surveys, reviews audit adjustments and settlements, and files appeals and exception requests to… more
- Highmark Health (Tallahassee, FL)
- …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
- CenterWell (Tallahassee, FL)
- …at the division and market level; Partners with Clinical Documentation Improvement, Audit , and Education to develop programs to improve clinical documentation. + ... development and compliance with coding standards. + Partner with analytics and audit to identify coder errors and develop plans to address deficiencies/specific… more
- Prime Therapeutics (Tallahassee, FL)
- …internal and external distribution Compliance Committee and the Compliance and Audit Committee and supports the Chief Compliance Officer's compliance governance ... Supports new client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid) + Other duties as assigned **Education & Experience** +… more
- CHS (Clearwater, FL)
- …and audits for claims which are in excess of payment authority limits in assigned audit queues. + Listen to and view all recorded customer service calls within the ... timeliness of claims processing. + Utilize Excel, prepares tracking and trending written audit reports based on findings and communicate audit findings with… more
- Humana (Tallahassee, FL)
- …to determine issues and improvements + Analyze and interpret Center for Medicare and Medicaid Services and Department of Insurance regulations to establish required ... + Research and analyze compliance information necessary to support internal and external audit activity. + Act as "Go To" person for resolution of issues relating… more
- Aveanna Healthcare (Panama City, FL)
- …communication standards within the office. + Payroll Assistance: Review weekly timesheets, audit payroll files, and serve as the primary contact for caregiver ... skills are a PLUS. Note: As an employer receiving Medicare and Medicaid funds, Aveanna employees must comply with...Aveanna's supportive and dynamic environment! As an employer accepting Medicare and Medicaid funds, employees must comply with all… more
- Healthfirst (FL)
- …York State regulations, job aides and HF policies. This includes review of performance audit reports in order to maintain superior and accurate care data for each ... programs such as MAP or MLTC + Knowledge of Medicare Regulations related to Long Term Care + Experience...care plan + Understanding of health plans such as Medicare , Medicaid and/or Managed Long-Term Care Plan (MLTCP) +… more
- Evolent (Tallahassee, FL)
- …of utilization review determinations, including appeals. + Provides input into audit processes including development of questions. + Reviews statistical sample of ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Datavant (Tallahassee, FL)
- …materials + Provide support to client relations for trainings needed for client audit findings + Research and analysis of coding error trends What you will ... and understanding of HCC mapping and models + Experience with coding Medicare , Commercial and Medicaid risk adjustment charts + Understanding of Medicare… more
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