- LA Care Health Plan (Los Angeles, CA)
- …Managed Health Care (DMHC), Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and other federal and state guidelines. ... Financial Compliance Auditor III Finance Job Category: Accounting/Finance Department:...design, implementation, and reporting of special projects such as Medical Loss Ratio. + Supports the design and implementation… more
- Humana (Richmond, VA)
- …to support Provider education efforts related to MCH and EPSDT. + Ensures compliance with state and federal requirements and NCQA standards that pertain ... first** Humana Healthy Horizons in Virginia is looking for a Quality Compliance Nurse Professional 2 (Maternal-Child Health/EPSDT) who will collaborate with all… more
- Atlantic Health System (Morristown, NJ)
- …assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines and provide ongoing feedback and analysis of ... codes and professional fee services performed by providers from medical records according to ICD-10, CPT, HCPCS, and CMS...+ Audit charts for accurate and correct coding and compliance within documentation guidelines and AHS policies + Prepares… more
- Fresenius Medical Center (Kennesaw, GA)
- …and Follow up teams to assure proper direction is obtained. + Assuring compliance with Medicare /Medicaid requirements and regulations by: + Maintaining current ... knowledge on Medicare , Federal , State and local regulations including...eight years supervisory experience. + Minimum of eight years medical regulatory and compliance experience. + Proficient… more
- Community Health Systems (Franklin, TN)
- Job Summary The Research Financial Manager, Administration and Compliance is responsible for oversight and management of sponsored research financial activities ... across the CHS enterprise while ensuring compliance with regulatory agency standards. This includes providing support and oversight from budget preparation, ensuring… more
- CenterWell (Shawnee, KS)
- …governmental and third party agencies, including State Departments of Health, CMS/ Medicare , Medicaid, and local governmental agencies and entities. + Conducting ... research of local, state, and federal statutes and regulations in support of company initiatives,...**Preferred Qualifications** + Knowledge of state regulations pertaining to compliance in the health industry + 1-2 years of… more
- Humana (Fort Drum, NY)
- …areas. This includes but is not limited to: + Member outreach calls + Medical record audits to evaluate provider compliance with clinical practice guidelines, ... internship that supports the goal to put health first? The Quality Compliance Professional intern will utilize Humana's training and mentorships and engage formerly… more
- Rush University Medical Center (Chicago, IL)
- **Job Description** Location: Chicago, Illinois Business Unit: Rush Medical Center Hospital: Rush University Medical Center Department: Rush Health Contracting ... to disease management and complex care management. Our network includes Rush University Medical Center, Rush Oak Park Hospital, Rush Copley Medical Center,… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …finalize most medical , dental, vision and drug benefit designs in compliance with state and federal mandates. Coordinates workflow among business partners ... Hybrid in our Brooklyn, Ohio office.** Founded in 1934, Medical Mutual is the oldest and one of the...self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.… more
- University of Rochester (Rochester, NY)
- … Medicare and Medicaid billing requirements. + Collaborates closely with the Medical Center's Office of Integrity and Compliance , providing analysis and legal ... issues such as Stark and Anti-Kickback, real estate, antitrust, billing compliance , contracts, equipment lease/purchase, medical records custody, and… more