- Elevance Health (Mason, 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 (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
- WelbeHealth (Columbus, OH)
- …growth drivers + Assist with month-end close, quarterly financial reporting, financial audit , Medicare /Medicaid audits, and other PACE specific projects + Keep ... payment model, including ability to track and analyze revenue streams (eg Medicare , Medicaid, Part D) along with PACE rates and regulatory constructs **Job… more
- Humana (Columbus, OH)
- …other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how ... participate in meetings involving care management, provider relations, quality of care, audit , grievance and appeal and policy review. The Behavioral Health Medical… more
- Molina Healthcare (OH)
- …from regulatory agency through analysis and response to findings. * Organize audit submissions, interact directly with auditors for all lines of business as ... of internal corrective action plans (CAPs) for both internal and external audit findings via coordination of responses to assure appropriateness as it relates… more
- Molina Healthcare (Cincinnati, OH)
- …durable fixes, and convert disciplined CTM management into Stars gains, audit readiness, and measurable member-experience improvements. You'll begin as a senior ... related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with CMS CTM… more
- Molina Healthcare (Cincinnati, OH)
- …Data Validation) team, assisting in the execution of CMS and internal audit activities. This position contributes to the development of chart retrieval chase ... gain exposure to end-to-end RADV workflows and contribute to meaningful audit readiness efforts. **Knowledge/Skills/Abilities** + Assist with the identification and… more
- Grant Thornton (Cleveland, OH)
- …and the overall effectiveness and efficiency of processes. + Oversee internal audit outsourcing and co-sourcing engagements for clients. + Manage the risk ... such as the Office of Inspector General (OIG) and the Centers for Medicare and Medicaid Services (CMS). + Experience with Sarbanes-Oxley Section 404 compliance. +… more
- Humana (Columbus, OH)
- …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
- 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