- Commonwealth Care Alliance (Boston, MA)
- …This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for ... as necessary on all new and revised coding logic, related Medicare /Medicaid policies for review/approval through the Payment Integrity governance process.… more
- Ventura County (Ventura, CA)
- …I- Four (4) years of progressively responsible experience as an accountant, auditor , analyst, or equivalent which included responsibilities for the evaluation of ... Five (5) years of progressively responsible experience as an accountant, auditor , analyst, or equivalent which involved healthcare (hospital, behavioral health,… more
- AdventHealth (Altamonte Springs, FL)
- …activities. These activities include preparation and filing the annual Medicare , Medicaid, and Champus/Tricare cost reports; preparation of reopening and ... of proposed operational decisions; and serves as subject matter resource for Medicare and Medicaid reimbursement matters. The Director is responsible for creating a… more
- Beth Israel Lahey Health (Charlestown, MA)
- …deep knowledge of both government and commercial payment systems; and, (4) Provide Medicare , Medicaid, and payment system expertise in support of BILH provider and ... VP and AVP, the Director will develop long- and short- term Medicare , Medicaid, and other government reimbursement revenue strategies, oversee preparation and… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Supports corporate and ... lifecycle processes for all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid), including HEDIS audit submission, Consumer Assessment… more
- NHS Management, LLC (Athens, AL)
- …other business office related tasks, including but not limited to: + Medicaid, Medicare and/or secondary billing + Assist with evaluation and selection of all ... required by Administrator, Financial Specialists, Financial Specialist Consultants, Internal Auditor , or any other corporate or regulatory compliance consultant.… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for ... DOH, CMS regulations and standards if managing members of Medicare programs, and other regulatory requirements as applicable. +...NYS DOH, CMS, NCQA, and HEDIS, serving as internal auditor within the group. + Responsible for all aspects… more
- Baystate Health (Springfield, MA)
- …applications in daily work: C Word, OA Gold, SMS, CIS, Premise, BMD, PCM Auditor , People Soft and Staples and Kronos access if applicable. **3)** Unit specific ... to transfer and discharge. Explains and obtains signatures for Medicare forms. Organizes chart for Medical Records, faxes or...record on unit. When appropriate, enter data into PCM auditor at specified times. Replenish and restock unit audit… more
- Humana (Springfield, IL)
- …Degree + Advanced certification such as Certified Public Accountant, Certified Information Systems Auditor , or Certified Internal Auditor is required + 10 or ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Baystate Health (Springfield, MA)
- …in daily work: C Word, OA Gold, SMS, CIS, Premise, BMD, PCM Auditor , People Soft and Staples, and Kronos access if applicable. **3)** Unit-specific projects: ... to transfer and discharge. Explains and obtains signatures for Medicare forms. Organizes charts for Medical Records, and faxes...the unit. When appropriate, enter data into the PCM auditor at specified times. Replenish and restock unit audit… more