- Banner Health (AR)
- …knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group (APR-DRG) and Ambulatory Payment ... ensure that clinical coding is accurate for proper reimbursement and that coding compliance is complete. Provides feedback on coding work and trends, and offers… more
- Humana (Atchison, KS)
- …role. **Preferred Qualifications:** + Master's Degree + Knowledge of the Medicare Advantage market, products, regulations, and compliance standards **Additional ... to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Evolent (Helena, MT)
- …is preferred + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified ... in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission… more
- Mount Sinai Health System (New York, NY)
- …Description:** + Ensure Compliance with NYS Prenatal Care Regulations + Ensure compliance with Medicare Teaching Physicians rules (TPR) - This relates to ... a Health Care Innovation Award from the Centers for Medicare and Medicaid Services to open the first geriatric...is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude,… more
- Evolent (Helena, MT)
- …is preferred + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified ... in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission… more
- Evolent (Helena, MT)
- …Computer Proficiency . Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified ... in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission… more
- Redeemer Health Home Care & Hospice (Meadowbrook, PA)
- …and Pathophysiology/Disease Processes/Pharmacology required. . Works claim edits identified along with compliance of the Medicare Coverage Determinations ( MCD ) ... ICD-10 and CPT-4 guidelines, UHDDS sequencing guidelines, CMS coding guidelines, Medicare and Medicaid regulations and the American Hospital Association coding… more
- Point32Health (Canton, MA)
- …strategies designed to produce medical or administrative cost savings, or assure compliance with federal and state regulations, including but not limited ... contract reimbursement for approximately 30 different ancillary service lines for Medicare , Medicaid and Commercial product lines. The Director also identifies… more
- DiPasquale Moore (Kansas City, MO)
- …managing all claims related to health insurance and their liens, including Medicaid, Medicare , and ERISA. This role is crucial in ensuring that our clients' ... settlements. * Manage the lien resolution process for Medicaid, Medicare , and ERISA claims. * Ensure timely and accurate...and track the status of lien claims to ensure compliance with all regulations and deadlines. Negotiation and Reduction:… more
- Aveanna Healthcare (Worcester, MA)
- …Clinical Supervisor or similar leadership role (preferred) + Deep understanding of state/ federal compliance and private duty nursing operations + Strong ... regulatory standards, and Aveanna policies to ensure top-tier care and compliance . + Provide On-Call Leadership:Be a consistent, reliable resource for clinical… more