- Commonwealth Care Alliance (Boston, MA)
- …Summary: Reporting to the Director, Claims Operations & Quality Assurance, the Regulatory Compliance & Audits Sr. Specialist II is responsible for ensuring CCA's ... and federal healthcare regulations, particularly MassHealth (Massachusetts Medicaid) and CMS Medicare requirements. This role is housed within the Claims Operations… more
- Community Health Systems (La Follette, TN)
- …are submitted in accordance with regulatory guidelines and organizational policies. The Medicare Billing Specialist supports compliance with federal and ... **Job Summary** The Medicare Billing Specialist is responsible for...Ensures documentation and billing practices align with audit and compliance expectations. + Escalates unresolved billing issues or delays… more
- Commonwealth Care Alliance (Boston, MA)
- …reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare ) + Medical Coding, Compliance , Payment Integrity and Analytics ... under the direction of the Sr. Director, TPA Management and Claims Compliance , Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing… more
- Commonwealth Care Alliance (Boston, MA)
- … Medicare , and commercial payment methodologies and supports audit, compliance , and provider engagement initiatives. This role also provides support in ... have direct reports. **Essential Duties & Responsibilities:** + Analyze MassHealth and Medicare claim reimbursements to ensure compliance with contractual terms,… more
- SUNY Upstate Medical University (Syracuse, NY)
- …resources. Ensure accurate coding and documentation to support quality initiatives and Medicare compliance . Work closely with clinical teams across seven Primary ... is seeking a Registered Nurse (RN), or Certified Nurse Specialist (CNS), to coordinate and conduct Medicare ...Nurse Specialist (CNS), to coordinate and conduct Medicare Annual Wellness Visits (AWVs) across seven Primary Care… more
- Cedars-Sinai (CA)
- **Job Description** The Managed Care Compliance Specialist is responsible for assisting with the implementation of the internal auditing and monitoring program ... Los Angeles and beyond. **Req ID** : 11981 **Working Title** : Managed Care Compliance Specialist - Managed Care **Department** : MNS Managed Care **Business… more
- Trinity Health (Livonia, MI)
- …and periodic risk assessments in support of the Trinity Health Integrity & Compliance Program (ICP). Risk assessments consider legal and regulatory compliance ... Health & Human Services (DHHS) - Office of Inspector General (OIG), Centers for Medicare & Medicaid Services (CMS), Department of Justice (DOJ) as well as input… more
- Ventura County (Ventura, CA)
- …and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare , and general insurance reimbursement ... Medicare and prepares reports; + Serves as lead biller/ specialist to the department; and + Performs other related...with billing and processing claims for timely reimbursement and compliance with Medi-Cal, Medicare , and general insurance… more
- NTT America, Inc. (Plano, TX)
- …adaptable, and forward-thinking organization, apply now. We are currently seeking a Corporate Compliance Specialist Advisor to join our team in Plano, Texas ... client accounts in ensuring our organization meets its HIPAA and healthcare- compliance -related obligations, including Medicare and Medicaid standards. This role… more
- Integra Partners (Troy, MI)
- The Medical Policy & Compliance Specialist is responsible for researching, analyzing, and interpreting CMS ( Medicare ) and state Medicaid guidelines to ensure ... improvement initiatives across the company. Salary: $110,000/Annually The Medical Policy & Compliance Specialist responsibilities include but are not limited to:… more