- Molina Healthcare (Columbus, OH)
- …order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with ... and makes determinations as to whether the investigation and/or audit identified potential fraud, waste, or abuse. + Coordinates...+ Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. + Understanding of… more
- Trinity Health (Columbus, OH)
- …to end 04/04/2026 **Why MediGold?** MediGold (https://medigold.com/) is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare ... wide variety of professional roles including information technology, financial analysis, audit , provider relations and more. **About the job:** Provider Service… more
- CVS Health (Columbus, OH)
- …with heart, each and every day. **Position Summary** + Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and ... ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of...International Classification of Disease (ICD) codes. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and… more
- Humana (Columbus, OH)
- …documented procedures/regulations/professional standards with some interpretation + Supports the Audit and Process Improvement teams by providing feedback to Care ... successfully working as a Care Manager/Care Coach/Care Coordinator/Service Coordinator in a Medicare or Medicaid market **OR** two (2) or more years of professional… more
- 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
- Continuing Healthcare Solutions (Cleveland, OH)
- …facility Business Office staff. This position will have responsibility for billing Medicare , Medicaid and/or Commercial insurance. This position will also audit ... long term care business office is preferred + Prior SNF biller experience of Medicare , Medicaid and Insurance experience preferred + Experience with PCC and RFMS is… more
- Prime Therapeutics (Columbus, OH)
- …reporting to the Corporate Compliance Committee (CCC) and Finance, Compliance & Audit Committee (FCA) meeting materials. + Act as a liaison between technical ... or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) +...related area of study, such as Juris Doctor + Medicare Part D, Medicaid, and/or Affordable Care Act knowledge… more
- OhioHealth (Columbus, OH)
- …expense tracking through study or grant closeout. Responsible for interaction with Medicare and applying Medicare regulations for device trials. Responsible for ... 10% Compliance Review research-related transactions for compliance. Assume responsibility for audit preparedness activities for OHRI RBS. Auditing patient records in… more
- Evolent (Columbus, OH)
- …of utilization review determinations, including appeals. + Provides input into audit processes including development of questions. + Reviews statistical sample of ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Humana (Columbus, OH)
- …+ Identify opportunities across HEDIS processes to ensure compliance and audit requirements are satisfied, while also simultaneously maximizing gap closure + ... Interpretation of the NCQA technical specifications and regulatory audit requirements to partner on data/process updates; and to provide insights, impacts and… more