- Independent Health (Buffalo, NY)
- …required. + Prior experience in customer service required, preferably in a healthcare setting. Experience working with provider offices is strongly preferred. Proven ... contacts into appropriate systems and maintain accurate documentation to meet external audit guidelines. + Meet or exceed all department standards in quality,… more
- RWJBarnabas Health (Newark, NJ)
- …of various clinical and financial operational processes within the healthcare industry. Demonstrated leadership and organizational skills with the ability ... operational performance. Strong understanding of payer rules, reimbursement methodologies, healthcare billing and coding. Essential Functions: Supervises the timely… more
- Health Care Service Corporation (Richardson, TX)
- …needed for contract financial analysis and performance; coordination of internal/external audit requests; performing routine and ad hoc reporting; and maintaining an ... requirements. + 6 years experience in a managed care healthcare environment. + 5 years experience in one or...in one or more of the following or similar claims adjudication and pricing systems: Blue Chip, MHS or… more
- CareFirst (Baltimore, MD)
- …retrospective risk adjustment supplemental filing, Risk Adjustment Data Validation (RADV) audit and any other chart coding functions, by performing moderately ... by the federal government. Develops and conducts new physician/other healthcare practitioner coding orientation/education, including group or individual sessions.… more
- Navy Exchange Services (NEX) (Virginia Beach, VA)
- …for our military service family members. A few of our benefits include: ⭐ Federal Healthcare ⭐ Dental, Vision, 401(k), & Pension Plan ⭐ Accrual of paid time off ... completed work for scheduled progress payments. Participates in the compilation of audit -ready contract files and the review of completed official contract files to… more
- Centene Corporation (Columbia, SC)
- …skilled in pulling, combining, and splitting records. + Prior experience with claims , which will be considered a significant advantage. + Standard hours are ... to plan timeline, and vendor oversight for timeliness and quality + Conduct quality audit and maintain all data and process controls to ensure compliance + Performs… more
- The Cigna Group (St. Louis, MO)
- …organization. + 5+ years of experience in supporting and participating in DOL audit activities and investigations/interviews to resolve DOL claims and actions. + ... improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of… more
- University of Rochester (Brighton, NY)
- …to, the Anti-Kickback Statute, the Physician + Self-Referral Law, the False Claims Act, Civil Monetary Penalties, and + Medicare and Medicaid billing regulations ... and other regulatory matters. + Advises on and drafts self disclosures, audit responses, and legal challenges to payor overpayment and adverse payment determinations… more
- MD Anderson Cancer Center (Houston, TX)
- …including researching root causes and updating the billing system to ensure claims are compliant and accurately submitted. Notify management of any systemic or ... projects and reporting purposes. Develop and oversee charge reconciliation and audit workflows for professional and technical services to ensure completeness and… more
- Insight Global (Brentwood, TN)
- …CRM handoffs, secure file transfers, APIs, and billing feeds for eligibility, claims , and remittances. . Manage data migration processes including mapping, data ... CMHAs, and other applicable standards; safeguard data quality and maintain audit trails. . Maintain detailed project documentation including decision logs, issue… more