- Elevance Health (Columbus, OH)
- …Medicare and Medicaid Services to transform federal health programs._ The ** Audit and Reimbursement Senior** will support our Medicare Administrative Contract ... + Requires a BA/BS and a minimum of 8 years of audit /reimbursement or related Medicare experience; or any combination of education and experience which would… more
- Elevance Health (Independence, OH)
- … Medicare and Medicaid Services to transform federal health programs. The ** Audit and Reimbursement III** will support our Medicare Administrative Contract ... a BA/BS degree and a minimum of 5 years of audit /reimbursement or related Medicare experience; or any combination of education and experience, which would… more
- Elevance Health (Mason, OH)
- …Requirements:** + Requires a BA/BS degree and a minimum of 5 years of audit /reimbursement or related Medicare experience; or any combination of education and ... ** Audit & Reimbursement III** **Location** : This role...Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare… more
- Elevance Health (Columbus, OH)
- … Medicare and Medicaid Services to transform federal health programs. The ** Audit and Reimbursement II** will support our Medicare Administrative Contract ... ** Audit & Reimbursement II** **Location:** This role enables...(MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department… more
- Molina Healthcare (Dayton, OH)
- …with the standards and requirements established by the Centers for Medicare and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the ... to members or authorized representatives in accordance with Centers for Medicare and Medicaid standards/requirements. * Provides direct oversight, monitoring and… more
- Medical Mutual of Ohio (OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Acts as a subject ... matter expert and collaborates with various internal departments to ensure that Medicare Advantage (MA) clinical programs and regulatory reporting are compliant with… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …protocols which align with Bon Secours Mercy Health's overall compliance audit and compliance responsibilities relative to hospital revenue cycle services performed ... procedures for the development of compliance internal monitors and audit protocols and the prevention of fraud, waste and...hospital revenue cycle risk areas highlighted by the OIG, Medicare , State Medicaid, State Insurance Fraud; Managed Care or… more
- Trinity Health (Columbus, OH)
- …A thorough understanding of NCQA and HEDIS is required. Knowledge of Medicare Stars-including CAHPS, HOS, Part D, and operational measures-is strongly preferred. ... **Why MediGold?** MediGold (https://medigold.com/) is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across… more
- Intermountain Health (Columbus, OH)
- …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 (Columbus, OH)
- …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