- Centene Corporation (Tallahassee, FL)
- …of risk adjustment regulatory landscape preferred + Risk Adjustment regulatory audit experience preferred + Medicare experience preferred Pay Range: ... Adjustment processes. Ensures visibility by way of reporting out audit deliverables and risk related to each audit . + Serves as the point of contact for external… more
- Humana (Tallahassee, FL)
- …expertise and passion for accuracy will make a meaningful impact. As the Nurse Audit Manager, you will spearhead audit and validation processes to ensure medical ... of all relevant coding. + Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management. + Applies clinical… more
- AdventHealth (Altamonte Springs, FL)
- …activities. These activities include preparation and filing the annual Medicare , Medicaid, and Champus/Tricare cost reports; preparation of reopening and ... appeal papers, audit preparation and other cost report settlement activity and...operational decisions; and serves as subject matter resource for Medicare and Medicaid reimbursement matters. The Director is responsible… more
- Highmark Health (Tallahassee, FL)
- …risk activities, including but not limited to internal and external audit progress, recurring risk and compliance reporting, mandated training, investigations, and ... of managed care operations, compliance program structures, information security and audit methodologies. The incumbent must also have a foundational understanding of… 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
- Molina Healthcare (Miami, FL)
- …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,...to ensure accuracy, completeness, and compliance with Centers for Medicare and Medicaid Services (CMS) regulations and guidelines of… more
- NHS Management, LLC (Daytona Beach, FL)
- …with internal controls and state and federal regulations. + Ability to audit resident accounts, assess accuracy and collectability of accounts receivable balances, ... other business office related tasks, including but not limited to: + Medicaid, Medicare and/or secondary billing + Assist with evaluation and selection of all… more
- Banner Health (FL)
- …knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group (APR-DRG) and Ambulatory Payment ... 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… more
- Molina Healthcare (Tampa, FL)
- …Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay ... + Manages Scorable Action Items (SAIs) related to pre-pay editing, post-pay audit , and overpayment recovery initiatives to ensure Health Plan SAI targets are… more
- TEKsystems (Miami, FL)
- TekSystems is currently hiring for SEVERAL Medicare Provider Services Representatives. These positions MUST be on EST time zone to qualify! MUST HAVE: Any ... Medicare or medical or provider services representative experience (At...is responsible for responding to all Department of Health audit calls on a consistent basis. Acts as a… more