• RN , Quality Improvement Specialist

    Trinity Health (Columbus, OH)
    …, a college of nursing (https://www.mccn.edu/) , a Medicare Advantage plan (https://www.medigold.com/) , and extensive outreach and ... community wellness programs, Mount Carmel Health System (https://www.mountcarmelhealth.com/) serves more than a million patients in...+ Serves as a QI liaison with external agencies ( CMS , ODH, TJC, etc) as well as Trinity Health… more
    Trinity Health (07/30/25)
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  • Program Manager Accreditation

    Cleveland Clinic (Mayfield Heights, OH)
    …those of: The Joint Commission (TJC), Ohio Department of Health (ODH) and Center for Medicare and Medicaid Services ( CMS ). + Act as the primary resource for ... two years of hire. + Five years of related experience with Quality Management , Risk Management /Patient Safety and Performance Improvement program or related… more
    Cleveland Clinic (07/24/25)
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  • Compliance Analyst (MI Health Plan) - REMOTE…

    Molina Healthcare (OH)
    …inquiries. + Performs Plan Required Reporting. + Interpret and analyzes Medicare , Medicaid and MMP Required Reporting Technical Specifications. + Create and ... quarterly Key Performance Indicator (KPI) reports. + Support the management of the regulatory memo distribution process Ability to...notices of proposed rulemaking. + Manages user access to CMS . + Analyze data use critical thinking + Ability… more
    Molina Healthcare (07/19/25)
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  • Facility Coding Inpatient Complex Coder

    Banner Health (OH)
    …and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services ( CMS ), Office of the Inspector General (OIG) and the ... certification in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC). Requires… more
    Banner Health (07/10/25)
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  • Claims Adjudication Specialist - Remote

    Cognizant (Columbus, OH)
    …ICD-10 * Experience making payments with UB/institutional ( CMS -1450) and/or professional ( CMS 1500) claims * Knowledge of Medicare / Medicaid payment and ... Responsible for reviewing the data in the claim processing system and comparing with corresponding UB or HCFA paper...Assigning special projects or other duties as determined by management . **What you need to have to be considered:**… more
    Cognizant (08/15/25)
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  • Medical Claims Adjudication - remote

    Cognizant (Columbus, OH)
    …+ Experience making payments with UB/institutional ( CMS -1450) and/or professional ( CMS 1500) claims. + Knowledge of Medicare /Medicaid payment and coverage ... and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or HCFA paper...and external SLAs. + Other duties as assigned by management . **Qualifications:** + A minimum of 2 years' claims… more
    Cognizant (08/01/25)
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  • Auditor, Risk Adjustment (Remote)

    Molina Healthcare (Cincinnati, OH)
    …and procedures to ensure accuracy, completeness, and compliance with Centers for Medicare and Medicaid Services ( CMS ) regulations and guidelines of risk ... CPC credential **Preferred Education** Bachelor's Degree in Business Administration, Health Care Management o To all current Molina employees: If you are interested… more
    Molina Healthcare (07/25/25)
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  • Social Scientist IV

    Battelle Memorial Institute (Columbus, OH)
    …or endorsing clinical quality measures + 5+ years working on Centers for Medicare & Medicaid Services ( CMS ) contracts + Demonstrated success writing federally ... organize project resources, project deliverables; and other related project management activities for multiple projects. + Participate in scientific conferences,… more
    Battelle Memorial Institute (07/18/25)
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