- Humana (Louisville, KY)
- …development and management, or a related technical role + Strong experience with healthcare data, particularly clinical and claims data used in **HEDIS ... source selection of a complex data pipeline that powers our CMS HEDIS ( Healthcare Effectiveness Data and Information Set) rules engine. This role bridges product… more
- Elevance Health (Indianapolis, IN)
- …claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. + Prepares correspondence to providers ... eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing… more
- Geisinger (Danville, PA)
- …to Benefits, Finance, Pricing, Billing and Dunning, Consumer Driven, Provider set up, Claims and Workflow and other areas of configuration and operations. Assists in ... and issues resolution of Workflow rules that allow for automation of claims processing. + Configures the eligibility process, the configuration migration utility… more
- Banner Health (OH)
- …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
- 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
- Henry Ford Health System (Troy, MI)
- …for appropriate billing documentation. + Reconcile performance reports with internal data. + Audit claims reports against system reporting for accuracy. + Review ... PDP alignment. #LI-KS1 EDUCATION/EXPERIENCE REQUIRED: + Bachelor's degree in healthcare related field such as BSW, BSN, health management/administration, Project… more
- Delta Dental of Iowa (Johnston, IA)
- …this role, you will help ensure regulatory compliance by maintaining audit -ready documentation, tracking issues, translating complex healthcare regulations into ... healthcare regulations, including HIPAA, HITECH, ERISA, the False Claims Act, the Anti-Kickback Statute, Medicare Advantage, Medicaid, and CMS requirements.… 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
- CACI International (San Antonio, TX)
- …verify payment histories and invoice statuses. + Collaborate with the Defense Contract Audit Agency (DCAA) and Defense Contract Management Agency (DCMA) to confirm ... audit status and final project acceptance. + Request and...CO approval, including draft DD Form 1594s, release of claims , and other necessary paperwork. + Input contract obligations… more
- Robert Half Finance & Accounting (Waianae, HI)
- …opportunity to contribute to the financial stability and transparency of a healthcare -focused organization. To apply, please call Erica Huggins at ###. Preference ... Awards to meet reporting requirements. * Review accounts payable claims for accuracy and monitor unclaimed payments to ensure...to enhance grant compliance and operational efficiency. * Create audit work papers and provide support during audit… more