- Elevance Health (Atlanta, GA)
- …potential issues, project change, and scope data, with a focus on payment accuracy, claims validation, and audit readiness. + Leads efforts to identify best ... business needs, including those unique to payment integrity and claims operations. + Designs methods for integrating functions and...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Otsuka America Pharmaceutical Inc. (Rockville, MD)
- Otsuka is a global healthcare company that has been in business for more than 100 years driven by the corporate philosophy: "Otsuka people creating new products for ... but not limited to Compliance Committee updates, quarterly reports to the OAPI/OPDC Audit & Risk Committee and Joint Boards of Directors, Annual reports, and updates… more
- UCLA Health (Los Angeles, CA)
- …to ensure financial accuracy and policy compliance. You will also lead audit response efforts, support strategic initiatives, and deliver insights that shape UCLA ... will: + Prepare and file annual Medicare and Medi-Cal cost reports; lead audit responses for intermediaries, PwC, and CMS. + Calculate and book monthly contractual… more
- FlexStaff (Chappaqua, NY)
- …*THIS IS A HYBRID POSITION- YOU MUST RESIDE LOCALLY* Are you passionate about healthcare compliance and eager to make a meaningful impact? FlexStaff is seeking a ... and regulatory adherence. In this pivotal role, you'll leverage your healthcare environment experience-whether as a Certified Professional Coder or similar… more
- Outreach Development Corporation (Richmond Hill, NY)
- …investments to optimize returns and align with the organization's values. Audit and Internal Controls + Collaborate with external auditors to facilitate ... the annual audit process and address any audit findings....services are accurately coded and billed in compliance with healthcare regulations, and payer requirements (eg, Medicare, Medicaid, Managed… more
- UNUM (Chattanooga, TN)
- …and maintain quality assurance (QA) programs for leave of absence, ADA and STD claims , including audit protocols, scoring criteria, and feedback loops. + Align ... Develop and execute a comprehensive quality strategy that ensures leaves and claims are adjudicated accurately, consistently, and in compliance with all regulatory,… more
- Banner Health (AR)
- …to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of ... information from a variety of sources. 2. Reviews medical records. Performs an audit of clinical documentation to ensure that clinical coding is accurate for proper… more
- Novant Health (NC)
- …Strategy will lead payer accountability and manage contract performance and the defense audit team. This role is critical in ensuring the optimization of revenue ... Management: Provide strategic direction and leadership to the payer strategy and defense audit team, ensuring alignment with the overall goals of the revenue cycle… more
- The County of Los Angeles (Los Angeles, CA)
- …developing and implementing the Quality Improvement program for these sections. + Reviews audit and monitoring tools on an on-going basis to ensure applicability and ... revises these tools and/or develops new audit tools. + Performs administrative work related to role...work related to role as Emerging Infectious Disease and Healthcare Recovery and Business Continuity Program Manager. + Participates… more
- Baystate Health (Springfield, MA)
- …requirements. Data Analysis: Experience in data analysis and the ability to interpret healthcare utilization data, claims data, and financial reports is often ... 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