- Prime Therapeutics (Columbus, OH)
- …federal and state regulatory inquiries + Develop and implement litigation and risk management strategies that align with Prime's business objectives, mitigate ... risk and protect the company's brand and business +...and regulations such as HIPAA, Anti-Kickback Statute, and False Claims Act, with a focus on PBM and managed… more
- ARCO (Cincinnati, OH)
- …and negotiating? Do you want to better understand the business considerations that inform risk management decisions? Are you looking to be a part of a dynamic ... legal-adjacent issues in the construction industry + Assess and mitigate ARCO's risk and provide suggestions to General Counsel and business leadership + Maintain… more
- Banner Health (OH)
- …coding expertise to resolve issues and support appropriate reimbursement. Proficiency in claims software to address coding edits and claim denials utilizing multiple ... of trends in DRG (MS/APR-DRG), APC, HCC, other Heath Risk Adjusted Factors, National Correct Coding Initiative (NCCI) and...and must be familiar with coding and abstracting software, claims processing tools, as well as common office software… more
- Evolent (Columbus, OH)
- …found by testing teams during test execution + Consult with the manage and report risk , issues, and decisions with the lead / manager + Responsible to attend and if ... - Payer side, Knowledge of Medicare, Medicaid, Commercial Plans and understanding on claims workflow, members, providers + A minimum of 1 years of experience in… more
- GE Aerospace (Evendale, OH)
- …aspects of the customer relationship, including purchase order execution, delivery, warranty claims , and dispute resolution. You will work on-site in Evendale, OH, ... + Manage all aspects of the GE/customer relationship, including delivery, warranty claims , cash collections, and dispute resolutions. + Partner with the GE Aerospace… more
- Molina Healthcare (OH)
- …responsible for the holistic management of the external vendor relationships for Claims and Enrollment activities (along with other Core Ops areas of ... and benefit realization + Demonstrates deep understanding of Core Operations, Claims and Enrollment processes, deliverables, vendor partners and technology platforms… more
- BrightSpring Health Services (Canton, OH)
- …leads staff, coordinates individualized supports, ensures quality outcomes, manages risk , and supports strategic initiatives, census development, and operational ... care and service delivery. + Identify and report incidents and potential risk situations promptly, ensuring timely and accurate documentation in compliance with… more
- Advatix, Inc. (OH)
- …eliminate hazards and reduce risk effectively + Contributes to property risk management, environmental compliance, and workers' compensation claims + Help ... integrate safety processes into business operations, including audits and oversight at various sites + Stay informed about relevant safety laws and regulations affecting HR for Growth + Aid in sustainability reporting initiatives + Assist in developing the… more
- Molina Healthcare (Akron, OH)
- …focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and… more
- Humana (Columbus, OH)
- …to assess, investigate, audit and validate the mitigation of compliance risk across the organization. This team ensures that healthcare providers align ... cycle management (related to billing, coding, collections for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare records + Must… more