- 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
- Highmark Health (Columbus, OH)
- …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
- Trinity Health (Columbus, OH)
- …candidates will have a strong understanding of Medical claims particularly within Medicare guidelines. Researching claims that do not process as expected and ... applicable benefits. **Why MediGold?** MediGold (https://medigold.com/) is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare… 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
- 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. _This is a remote ... components of the corporate forecast, financial statements, regulatory reporting and/or audit schedules. + Analyzes general ledger account activity compared to prior… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Responsible for group ... to be measured for annual performance review.** **Maintains renewal pipeline and audit report on a monthly basis.** **.** **Establishes and maintains relationships… more
- Molina Healthcare (Cincinnati, OH)
- …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
- Banner Health (OH)
- …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 (OH)
- …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
- Ensono (Columbus, OH)
- …US Citizenship and pass related background checks including but not limited to Medicare and Medicaid and VA **Preferred Skills:** + Experience with secure file ... transfer protocols and audit /compliance requirements. + Ability to work in a hybrid...a strong background in implementing and maintaining Centers for Medicare & Medicaid Services (CMS) security standards and compliance… more