- WTW (North Canton, OH)
- …leading direct-to-consumer insurance services business, specializing in the distribution of Medicare Advantage, Medicare Supplement and Life & Supplemental ... ensure proper handling in the financial statements. + Assist with external audit requests. + Identify opportunities for process improvement and assist in… more
- Prime Therapeutics (Columbus, OH)
- …Subject Matter Expertise in their areas of focus (Affordable Care Act, Medicare , Medicaid, Corporate Compliance, Compliance Assessment or Services etc.) + Develop ... employee and leadership expectations + May oversee and support audit action plans and/or corrective action plans for the...or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) +… more
- Cardinal Health (Columbus, OH)
- …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 (Columbus, OH)
- …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
- Humana (Columbus, OH)
- …operational goals, including regulatory compliance requirements + Promotes and builds an " Audit Ready Every Day" culture + Further simplifies and improves processes ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Humana (Columbus, OH)
- …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
- CommuniCare Health Services Corporate (Cincinnati, OH)
- …RN license in Ohio + At least 2 years of experience with Federal Medicare /Medicaid and Managed Care reimbursement system management in working with the MDS and RAI ... and targets for utilization + Weekly visits to facilities for intervention, audit and training + Review resident clinical records for coverage, utilization, errors,… more
- Humana (Columbus, OH)
- …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 (Columbus, OH)
- …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
- Humana (Columbus, OH)
- …+ Building working relationships with internal stakeholders and supporting external audit preparation efforts. + Demonstrating an understanding of departmental and ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
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