- Highmark Health (Harrisburg, PA)
- …risk activities, including but not limited to, internal and external audit progress, recurring risk and compliance reporting, mandated training, investigations, and ... of managed care operations, compliance program structures, information security and audit methodologies. The incumbent must also have a foundational understanding of… more
- Commonwealth Care Alliance (Boston, MA)
- …Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare , and commercial payment methodologies and supports audit , compliance, and ... accurate, compliant, and timely reimbursements within the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims… more
- Centene Corporation (Olympia, WA)
- …federal health care laws, including laws applicable to managed care industry, Medicare , and Medicaid plans such as licensing requirements, prompt pay, and ... Compliance program, including communication to/from the Medicaid Agency, Medicaid Contracts, Annual Audit , and findings from that audit + Coordinate and document… more
- Covenant Health Inc. (Knoxville, TN)
- …+ Assurance of verification of benefits and authorization for services on all non- Medicare patients as obtained by intake and authorization staff. + Reviews on-call ... every morning. + Follows up on identified deficiencies related to the billing claims audit within 24 hours following receipt of the Billing Claims Held Reports. +… more
- BrightSpring Health Services (Louisville, KY)
- …Medical Services company, Population Health Management services company, and a Medicare Advantage Institutional Special Needs Plan (I-SNP).Under the direction of the ... While the primary focus of this position will be to support the Medicare Advantage Institutional Special Needs Plan (I-SNP), the Manager will work in collaboration… more
- Johns Hopkins University (Baltimore, MD)
- …key member on special projects and strategic institutional initiatives. + Provides timely audit reports of all JHHS clinicians to the JHHS Compliance Department. + ... insurance. Collaborates with the JHHS Corporate Compliance Office to create audit processes for professional billing. + Proactively addresses JHHS compliance… more
- LA Care Health Plan (Los Angeles, CA)
- Compliance Advisor III Job Category: Administrative, HR, Business Professionals Department: Audit Services Location: Los Angeles, CA, US, 90017 Position Type: Full ... federal regulatory requirements, including but not limited to, the Centers for Medicare and Medicaid Services (CMS), the California Department of Health Care… more
- Highmark Health (Oklahoma City, OK)
- …OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and ... identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external … more
- State of Maine, Bureau of Human Resources (Augusta, ME)
- …position allows for partial telework with management approval. OVERVIEW: The Division of Audit is seeking a highly talented individual who will represent our ... AUDIT values (Accountability, Unity, Dependability, Integrity, and Trust) in...grow personally and professionally as you acquire knowledge of Medicare , Medicaid, and Federal grants. REQUIREMENTS: To qualify, you… more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... Under the general supervision of the Manager of Configuration Audit and Directories, staff will perform an audit... Audit and Directories, staff will perform an audit sampling of provider data within the symplr Payer… more