- Northwell Health (Garden City, NY)
- …and principals; performs coding audits for optimization. 4.Audits and reviews Medicare /non- Medicare charts to ensure that proper standards are maintained ... rules and regulations to the validation review process. 6.Reviews codes on Medicare /non- Medicare charts for compliance to rules and conventions. 7.Communicates… more
- Northwell Health (Westbury, NY)
- …the documentation in the Medical Record. Job Responsibility + Audits and reviews Medicare /non- Medicare charts to ensure that proper standards are maintained in ... regulations to the validation review process. + Reviews codes on Medicare /non- Medicare charts for compliance to rules and conventions. + Instructs professional… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …specific to hospital revenue cycle risk areas highlighted by the OIG, Medicare , State Medicaid, State Insurance Fraud; Managed Care or Governmental Value-Based ... or as an employee/manager required. + Demonstrated working knowledge of Medicare and Medicaid, Insurance Managed Care including documentation, coding, reimbursement… more
- Humana (Phoenix, AZ)
- …experience in revenue cycle management (related to billing, coding, collections for Medicare and Medicaid claims) + Experience with Auditing and monitoring of ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- YAI (Manhattan, NY)
- …agencies (Office for People with Developmental Disabilities (OPWDD), Centers for Medicare and Medicaid Services (CMS), Office of Medicaid Inspector General (OMIG), ... Department of Health (DOH)), etc. + Develops monitoring tools and checklists for use in internal audits to assess compliance with applicable regulations and identify areas of concern in preparation for external audits. + Supports program leadership with… more
- Molina Healthcare (Albuquerque, NM)
- …and procedures to ensure accuracy, completeness, and compliance with Centers for Medicare and Medicaid Services (CMS) regulations and guidelines of risk adjustment ... data * Understand and oversee RAPS and EDPS data transmission and assist in identification of issues that impact data integrity and accuracy * Identify opportunities for data mining to ensure data gaps are minimized * Apply best practices to ensure accuracy of… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …Experience Required: 2+ years of claim processing experience with a Medicaid/ Medicare Health Plan. Preferred: Experience in health insurance product environment. ... Specific Technical Skills Required: Proficiency with MS applications, including but not limited to Word, Excel, Outlook Certifications/Licensure: Required: n/a Knowledge and Skills: + Effective presentation skills + Excellent verbal and written communication… more
- Trinity Health (Ann Arbor, MI)
- …insurance and governmental programs, regulations, and billing processes (eg, Medicare , Medicaid, Social Security Disability, Champus, Supplemental Security Income ... Disability, etc.), managed care contracts and coordination of benefits is required. Working knowledge of medical terminology, and medical record coding experience (ICD-9, CPT, HCPCS) are highly desirable. Customer service background is required. Working… more
- Atlantic Health System (Morristown, NJ)
- …assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines and provide ongoing feedback and analysis of ... the education needs for the providers and staff; also responsible for assisting with coding inquiries from providers, charge posters, billing staff, etc. Principal Accountabilities: Coordinates, schedules, performs the professional services documentation and… more
- Baystate Health (Springfield, MA)
- …documentation for professional billing to ensure it meets the AMA and CMS ( Medicare ) guidelines for the services billed, reviewing and validating billed charges and ... performing benchmark reporting to determine outliers. Completes a variety of analyses and reports and maintains various department databases. The incumbent routinely interacts with employees at all levels. The incumbent has an understanding of compliance audit… more