- GEHA (Lee's Summit, MO)
- GEHA (Government Employees Health Association, Inc., pronounced GEHA) is a nonprofit member association that provides medical and dental benefits to more than two ... to federal employees in the United States, GEHA empowers health and wellness by meeting its members where they...Determine eligibility, benefits, and prior activity related to the claims , payment, or service in question. + Provide written… more
- BrightSpring Health Services (Vancouver, WA)
- …hour shifts Monday - Friday Our Benefits Include: + Competitive pay + Shift differential + Health , dental, & vision + Company paid STD & LTD + Paid Time Off + ... pharmacy operations and medication distribution, medication, storage and oversight . Audit all aspects of medication storage in the facility/community, including… more
- Baystate Health (Springfield, MA)
- …validity in the data and support the Managed Care Contract Team at Baycare Health Partners. The Sr. Managed Care Contract Manager, will also perform research and ... settlements 3) Will advise and support budgeting, month-end close, regulatory changes, and audit adjustments related to Medicare and Medicaid 4) As a Sr. Managed… more
- UCLA Health (Los Angeles, CA)
- …closely with physicians, IPA coders, and risk adjustment teams associated with the health plan. You will: + Conduct medical record audits for physicians (MD, DO, ... for providers and medical groups. + Participate in additional audit activities for CMS RADV as needed, including retrospective...Angeles area at least three days a week. UCLA Health salary range for this title code is $95,400-208,300/annually.… more
- BrightSpring Health Services (Louisville, KY)
- …entities in Primary Care including a Medical Services company, Population Health Management services company, and a Medicare Advantage Institutional Special Needs ... PowerBI, or other tools. + Prepare forecasting/recasting analysis & support: audit historic data, model current and future assumptions, coordinate and collaborate… more
- CommonSpirit Health (Englewood, CO)
- …of success in managing complex data environments and experience with healthcare claims and utilization datasets. If you are a motivated and dedicated healthcare ... are in line with industry standards and best practices. 5. Develop and implement audit and data quality control measures to ensure the integrity and reliability of… more
- Iowa Department of Administrative Services (Des Moines, IA)
- …(DPS) is seeking to fill a position within the Program Services Bureau's Audit / Certification/ Training (ACT) Team. Organization Background: The mission of DPS is to ... Uniform Crime Reporting (UCR) and Criminal Justice Information Systems (CJIS) Audit /Certification/Training (ACT) Team. This position serves primarily in the bureau's… more
- CareFirst (Baltimore, MD)
- …of financial business records, provider and subscriber medical data, claims , systems reports, medical records, analysis of contract documents, provider/subscriber ... claims history, benefits, external data banks and other documents...documentation to substantiate findings including formal reports, spreadsheets, graphs, audit logs, anti-fraud software and appropriately sourced reference materials.… more
- Ascension Health (St. Louis, MO)
- …**Location:** St. Louis, MO (Hybrid) **Benefits** Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match ... purchase card transactions. + Reconcile medical and pharmacy paid claims to supporting documentation. + Prepare monthly and annual... paid data as requested. + Assist with external audit requests. + Assist with preparing and submitting the… more
- Sedgwick (Cedar Rapids, IA)
- …work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and completes medical review of all ... claims to ensure information substantiates disability. + Provides clear...status, progress and work status. + Achieves appropriate quality audit scores on a consistent basis. + Acts as… more