- St. Luke's University Health Network (Allentown, PA)
- …and procedure code assignment and MS-DRG/APR-DRG accuracy based on denials or audit findings from government and commercial payers. Meet or exceed established ... the physician advisor in review of patient medical records identified by RAC /MIC/QIO and other governmental or commercial payor auditors in retrospective reviews for… more
- ASM Research, An Accenture Federal Services Company (Harrisburg, PA)
- …the data architecture strategies. + Implement and manage backup and disaster recovery procedures for Informatica repositories and configurations. + Work closely with ... JMS, PowerExchange, S3, S3 Delta, or Amazon RedShift. + Experience managing Oracle RAC and Data Guard databases. + Knowledge of UNIX/Linux commands and shell… more
- Highmark Health (Harrisburg, PA)
- …entities in response to external coding audits conducted by the Medicare Administrative Contractor , the RAC , MIC, ZPIC, etc. Determine appeal action, prepare ... OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and… more
- Parexel (Harrisburg, PA)
- …and 510(j)(3) reporting through nextGen portals is a plus * Ensure audit readiness and version control through meticulous documentation and system management ... in Pharmaceutics, Biochemistry, Molecular Biology, Biotechnology, or Biology preferred * RAC certification is a plus Given the client's location, preference will… more
- University of Pennsylvania (Philadelphia, PA)
- …templates). This individual communicates independently at all levels and ensures audit /inspection readiness of assigned projects. The Regulatory Affairs Specialist C ... templates). This individual communicates independently at all levels and ensures audit /inspection readiness of assigned projects. The Regulatory Affairs Specialist C… more
- University of Pennsylvania (Philadelphia, PA)
- …to senior leadership department-wide trial characteristics, accrual information and audit /monitoring findings; such reports will include an assessment of trial ... of clinical trial compliance and quality assurance through communication of audit results and compliance guidelines. + The Associate Director for Regulatory… more
- West Pharmaceutical Services (Exton, PA)
- …and Certifications** + Pharmaceutical and Medicine\Regulatory Affairs Certifications ( RAC )-RAPS Upon Hire preferred **Additional Requirements** + Ability to ... comprehend principles of math, science, engineering, and medical device use. + Ability to handle technical reports, drawings, specifications, regulatory and quality documentation with a high degree of confidentiality. + Ability to research, read, analyze, and… more
- St. Luke's University Health Network (Allentown, PA)
- …the physician liaison in review of patient medical records identified by RAC /MIC/CGI/QIO and other outside auditors in retrospective reviews for DRG and ... coding-related issues. May participate in review of other medical necessity issues as needed. + Develop and apply appeal arguments to defend the coding of and by the coding professionals and be able to refute the coding determination made by the outside payor… more
- Guthrie (Sayre, PA)
- …corporate revenue cycle forecast preparation, reporting, and updating. Works closely with RAC and Finance leadership to prepare and analyze forecast and actual ... expense data to support leadership. This role serves as the Revenue Cycle Revenue Integrity leader for The Guthrie Clinic to internal and external organizations, including government agencies, payor organizations, vendors, external auditors, and business… more
- Guthrie (Sayre, PA)
- Summary The Denial, Appeal, and Audit Manager is responsible for the oversight and management of all payer denials, appeals, and audit processes within the ... resolution of claim denials, effective appeal strategies, and proactive audit response. The manager leads a team of specialists,... Oversight + Manage payer and third-party audits (eg, RAC , MAC, UPIC, commercial payers) + Coordinate timely record… more