- 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
- UL, LLC (Allentown, PA)
- …+ Assess and report in accordance with UL, industry scheme, and client audit protocols on facilities working and/or operational conditions as it relates to ... Nutritional Supplements: 21CFR111 + Medical/Homecare Devices: 21CFR820 + Cosmetics: ISO22716 + Complete audit agendas within 14 calendar days of the audit +… 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
- Trinity Health (Langhorne, PA)
- …Maintains database of duplicate and overlay corrections for reporting purposes 11. Assists with RAC and other audit activity by entering needed data to track ... 4. Selects appropriate or defined sample size to support audit validity 5. As directed, performs audit ...support audit validity 5. As directed, performs audit of metadata to detect potential privacy breeches related… more
- 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
- 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
- UPMC (Pittsburgh, PA)
- …and assist with the assembly of training materials and CDI process. Assist with audit reviews including all internal, external, and RAC associated coding audits. ... Supervise on-site staff. Review and approve adjustments to accounts. Responsible for Kronos approval and sign-off. Responsibilities: + Adhere to internal system-wide policies, competencies, behaviors and procedures to ensure efficient work processes. Actively… 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