- Highmark Health (Oklahoma City, OK)
- …OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and ... identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external … more
- WMCHealth (Valhalla, NY)
- …up and maintained. + Software & Data Management + Maintain, test, and audit split-billing software and associated data feeds, ensuring accuracy and compliance. + ... Develop and refine claims qualification logic and data feeds for contract pharmacy...& Compliance Oversight + Develop and maintain a 340B audit compliance program, executing self-audits and implementing corrective action… more
- Tucson Electric Power (Tucson, AZ)
- …**leave programs** , including: o Manages all administrative aspects of leave claims to include tracking hours used/taken and working closely with Human Resources ... o Flags potentially fraudulent activity in leave cases and claims ; works closely with the HRBP team to identify,...UEE and UEG, and maintains working papers for each audit which document the work performed, conclusions reached, and… more
- Community Health Systems (Birmingham, AL)
- …reports issues, problems, and important information to management. + Works all vendor/payer audit trails and files secondary claims . + Performs other duties as ... companies or other payers. This position performs all needed research to ensure claims are filed timely, accurate and efficient in accordance with all billing… more
- Otsuka America Pharmaceutical Inc. (Princeton, NJ)
- …healthcare laws, regulations and guidance (such as the Anti-Kickback Statute, False Claims Act, OIG Guidance for Pharmaceutical Manufacturers, PhRMA Code, FDCA and ... trials, publications, and pricing agreements. Perform steps in the audit process including interviewing stakeholders, testing controls, communicating findings to… more
- Wolters Kluwer (Minneapolis, MN)
- …platforms. In addition, during heavy periods of incoming invoice volume, conduct the initial audit and/or quality assurance invoice review audit up to 15% of the ... prior supervisory experience, preferably in a legal billing or claims environment. + 5+ years' experience in the legal...and to exercise discretion and sound judgment when making audit and adjustment decisions. + Understanding of legal terminology… more
- Robert Half Legal (Addison, TX)
- …internal and external parties * Prepare responses to informal demands and claims * Coordinate with outside counsel on litigation or threatened litigation, deposition ... and document collection and review * Assist with employee-related claims (eg, EEOC and DOL charges) * Assist with...outside attorneys' bills * Work with accounting department during audit time for audit letters and document… more
- Pilgrim's (Greeley, CO)
- …full time at our Corporate office in Greeley, CO. Responsibilities: + Audit and publish product specifications for Pilgrim's processing plants within PLM recipe ... development + Maintain BRC audit process; cross reference projects within Pilgrim's project management system + Maintain communication site between Pilgrim's and… more
- Western Washington University (Bellingham, WA)
- …insurance company contracts and regulations. + Ensures compliance and completeness of claims for electronic submission. + Ensures proper billing by State and Federal ... regulations by overseeing coding audit efforts and coordinates monitoring of coding accuracy and...and any legal updates or other considerations. + Reviews claims denials and rejections pertaining to coding and medical… more
- Sysco (Hartford, CT)
- …(GFSI), audits by BRC, independent third parties, customers, and Sysco's internal audit process, analyze results, determine root cause, and gather corrective action ... plans for audit non-conformance(s). Reviews results with Field Food Safety Director....potential for food safety issues and to support the Claims Process with Sysco's 3rd party claims … more