- Beth Israel Lahey Health (Woburn, MA)
- …at the Beth Israel Deaconess Medical Center (BIDMC), the Revenue Integrity Senior Analyst contributes to Revenue Integrity and Coding oversight at the enterprise, ... compliance with applicable coding and billing guidelines, and optimization of reimbursement . * Support departments with analyzing services for coverage and … more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Business Operations Analyst assumes a pro-active approach in ensuring the accuracy and integrity of ... analyses and problem resolution to meet business operational requirements for Medicare Advantage(MA), Affordable Care Act (ACA) & Medicaid Lines of Business… more
- Molina Healthcare (UT)
- **JOB DESCRIPTION** **Job Summary** Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements ... related to but not limited to coverage, reimbursement , and processing functions to support systems solutions development and maintenance. This role includes… more
- Novo Nordisk (Plainsboro, NJ)
- …Inflation Reduction Act ("IRA") processes and compliance activities for the Medicare Drug Negotiation Program. Ensures accurate and timely input and implementation ... Provide support for SOX inquiries and ensure adherence to SOX controls. Performs post audit reviews and analysis of 340B PHS chargebacks and MFP rebates + Ensure… more
- Spurwink Services (Portland, ME)
- …and HIPAA) is required. Knowledge, Skills and Abilities Necessary: Proficient in Medicare , Maine Care, Commercial and WC billing, reimbursement and collections. ... Procedures. + Assist in A/R-related matters for the year-end audit , internal QA audits or audits by third-party funding...service) + Scholarships to ME Community Colleges + Tuition Reimbursement + 25% Tuition Reimbursement for UNE… more
- University of Southern California (Alhambra, CA)
- …specific to ICD-10-CM, ICD-10-PCS, CPT/HCPCS, DRGs, APCs, and Modifiers-from Medicare , Medi-Cal, MAC, RAC, and commercial insurance companies -when there ... and an argument and follow up with the PFS about possible reimbursement . Identifies, analyzes, and researches frequent root causes of denials and develops… more
- Northwell Health (Lake Success, NY)
- …code editor report to analyze, research and resolve issues related to Medicare outpatient claims that generate code editor edits. + Maintains current knowledge ... Classification (APC) groups, federal, state and regulatory agency coding and reimbursement changes and coding requirements to ensure hospital procedures and services… more
- Option Care Health (Bannockburn, IL)
- …Direct experience applying knowledge of Medicare , Medicaid, and Managed Care reimbursement guidelines. + Proficiency with audit software or other governance, ... and abuse, including but not limited to HIPAA, Anti-Kickback, Stark, Medicare /Medicaid reimbursement . + Experience evaluating information to determine compliance… more
- MetroLink (Los Angeles, CA)
- …purchase orders. + Prepare required reports, correspondence, and other items for review by senior staff. + Attend various meetings as needed. + Serve as a liaison ... amendments. + Conduct closeout actions upon contract completion such as final audit , payment, release of committed funds etc., under Management supervision and… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …departmental leaders to provide education on medical coding and documentation based on audit findings and as required by current CMS regulations. Work directly with ... and address coding discrepancies and recommend corrective actions + Prepare detailed audit reports with findings and provide feedback on documentation and coding… more