- Aveanna Healthcare (Atlanta, GA)
- …accuracy, and collaborate with HRIS teams to enhance system functionality. + Audit current compensation practices and policies, and make recommendations to improve ... time with or without notice. Vaccination Requirement As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements… more
- State of Georgia (Fulton County, GA)
- …the Georgia Medicaid Program; state and federal laws and policies governing Medicare and Medicaid. + Applies appropriate regulations, policies, and procedures to ... staff regarding any blatant compliance issues. + Accurately documents findings from audit on standard forms. + Participates in interviews of subjects and witnesses,… more
- STG International (Milledgeville, GA)
- …Coordinate Pre-certification sand recertification in accordance with facility policies for Medicare Advantage and + commercial insurance payers. + Interpret the ... facility surveys (inspections) made by authorized government agencies as requested. + Audit nursing documentation in the clinical record for appropriate and relevant… more
- Humana (Atlanta, GA)
- …+ Knowledge of Medicaid regulatory requirements + Experience with contracting, audit , risk management, or compliance **Additional Information** This position is open ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Datavant (Atlanta, GA)
- …outcomes, measure product impact, and support value-based client delivery across Medicare Advantage, ACA, and Medicaid programs. The ideal candidate combines deep ... **Quality, Compliance, and Scalability** + Ensure analytics products support audit defensibility, regulatory compliance, and documentation traceability. + Design… more
- Cardinal Health (Atlanta, GA)
- …for every interaction using the appropriate database for the inquiry + Must self- audit intake activities to ensure accuracy and efficiency for the program + Make ... prior authorizations, and appeals, preferred (2+ years) + Knowledge of Medicare , Medicaid and Commercially insured payer common practices and policies, preferred… more
- Highmark Health (Atlanta, GA)
- …will monitor internal referrals from sources such as claims, customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert Investigators of the need ... fraud waste and abuse cases; Prepare reports and other information to document audit findings. + Calculate over-payments in established fraud, waste and abuse cases.… more
- Fresenius Medical Center (Cartersville, GA)
- …as directed. + Participates in medical records, infection control, and other audit processes as directed. + Actively collaborates with others during staff huddles ... or state-specific certification as defined by the Center for Medicaid/ Medicare Services (CMS). + Allappropriatestatelicensure,education,andtraining(ifany) required. + Demonstrated commitment… more
- Humana (Fort Benning, GA)
- …internal and external stakeholders. + Provider outreach to close care gaps, audit records to identify improvement opportunities, and abstract data from records to ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Intermountain Health (Atlanta, GA)
- …and compliant application with charge/coding capture, charge editing, and audit and reimbursement practices. Researches and collaborates on regulation updates ... preceptor, trainer experience is preferred Knowledgeable of CMS Guidelines ( Medicare /Medicaid) To perform this job successfully, an individual must be able… more
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