- Methodist Health System (Dallas, TX)
- …and updates. Assist the CLO/CCO with agendas and meetings of the Audit & Corporate Oversight Committee and the Corporate Compliance Committee. + Collaborate ... business office, coding, physician contracting, fraud & abuse laws, Medicare /Medicaid regulatory requirements, privacy, or other compliance related subject matters.… more
- Highmark Health (Austin, TX)
- …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
- Sam Houston State University (Huntsville, TX)
- …eligible staff, faculty and graduate student employees. Supervises the data entry and audit of insurance actions in the Employees Retirement System of Texas ( ERS ... Board reports, Optional Retirement Program ( ORP ) Coordinating Board Reports, Medicare Data Match surveys, College and University Professional Association ( CUPA )… more
- Humana (Austin, TX)
- …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
- Intermountain Health (Austin, TX)
- …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
- SAIC (TX)
- …guidelines, and healthcare fraud; commercial reimbursement guidelines and policies; coding audit principles and concepts, and potential areas of risk for fraud ... Includes, but is not limited to: The Federal Register, Center for Medicare , and Medicaid Services (CMS) Local Coverage Determinations and National Coverage… more
- Fresenius Medical Center (Odessa, TX)
- …as directed. + Participates in medical records, infection control, and other audit processes as directed. + Actively collaborates with others during staff huddles ... or state-specific certification as defined by the Center for Medicaid/ Medicare Services (CMS). + Allappropriatestatelicensure,education,andtraining(ifany) required. + Demonstrated commitment… more
- Humana (Austin, TX)
- …+ 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
- Cardinal Health (Austin, TX)
- …for reporting any payer issues to the appropriate team + Must self- audit activities to ensure accuracy and efficiency for the program **_Qualifications_** + ... benefit investigations, prior authorizations, and appeals, preferred + Knowledge of Medicare , Medicaid and Commercially insured payer common practices and policies,… more
- CVS Health (Irving, TX)
- …examinations, and actions, research and analysis of state law related to pharmacy audit questions, PBM client requests and review of provider manual updates and ... insurance department market conduct exams and enforcement actions and in Medicare /Medicaid pharmacy network contracting. You will identify business and legal risks… more
Recent Jobs
-
Acute Care Nurse Practitioner or Physician Assistant - Per Diem Intensivists
- Hartford HealthCare (Bridgeport, CT)
-
Open Rank Pediatric Gastroenterologist
- University of North Carolina- Chapel Hill (Chapel Hill, NC)
-
Host (Food and Beverage, Retail, Attractions)
- LEGOLAND (North Richland Hills, TX)
-
Respiratory Therapist RRT PRN
- HCA Healthcare (Inverness, FL)