- Humana (Indianapolis, IN)
- …processing status and improvement opportunities to markets and Providers. + Partner with Medicare Risk Adjustment (MRA) and vendors to establish data feeds for STARs ... annual standard and nonstandard supplemental data audit with NCQA and DTS auditor . **Use your skills to make an impact** **Required Qualifications** + Bachelor's… more
- TEKsystems (Los Angeles, CA)
- …passion for healthcare claims and compliance? Join our team as a Claims Compliance Auditor , where you'll play a pivotal role in ensuring accuracy, efficiency, and ... + Lead audits and compliance reviews for HMO and Medicare claims + Analyze benefit structures and system configurations...+ ✅ Claims Audits, Resubmissions & Processing + ✅ Medicare Claims & Guidelines + ✅ EZCap System Experience… more
- Molina Healthcare (Owensboro, KY)
- …quality member intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid) Executes health plan's member and community quality ... or Healthcare Administration + 1 year of experience in Medicare and in Medicaid managed care + Certified Professional...be preferred for specific roles) + Certified HEDIS Compliance Auditor (CHCA) + Certified Community Health Worker (CCHW) +… more
- Molina Healthcare (El Paso, TX)
- …quality member intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid). Executes health plan's member and community quality ... skills. **PREFERRED QUALIFICATIONS:** + 1 year of experience in Medicare and in Medicaid managed care + Experience with...be preferred for specific roles) + Certified HEDIS Compliance Auditor (CHCA) To all current Molina employees: If you… more
- Hackensack Meridian Health (Edison, NJ)
- …conducts audits for medical provider documentation while adhering to Centers for Medicare and Medicaid Services (CMS) and Office of Inspector General (OIG) ... coding and auditing concepts, American Medical Association (AMA)/Centers for Medicare and Medicaid Services (CMS)/Office of Inspector General (OIG)/Federal/State… more
- Saint Francis Health System (Tulsa, OK)
- …Registration and/or Certification: Certified Public Accountant (CPA) or Certified Internal Auditor (CIA), preferred. Work Experience: Minimum 3 years of related ... knowledge of healthcare billing and reimbursement processes, particularly related to Medicare and Medicaid. Essential Functions and Responsibilities: Assists in the… more
- AdventHealth (Altamonte Springs, FL)
- …Medicaid third party financial settlement to be audited by AdventHealths external auditor for inclusion in the audited financial statements. + Proactively seeks to ... relevant experience in healthcare finance, preferably in reimbursement including Medicare , Medicaid reimbursement and regulatory cost reporting Strong background in… more
- Waystar (Atlanta, GA)
- …or CPA/CIA/CISA preferred. + 7+ years of audit experience, with recent roles as an auditor in a Big4 or national public accounting firm or as an Internal Audit/SOX ... hospitals and health systems, and is connected to over 5K commercial and Medicaid/ Medicare payers. We are deeply committed to living out our organizational values:… more
- The County of Los Angeles (Los Angeles, CA)
- …rules and regulations and result in maximum revenue collection. Prepares Medicare and Medi-Cal cost reports and State mandated disclosure reports. Analyzes ... Health Services or Mental Health, departmental administration and by the Auditor -Controller when necessary. Writes policy and procedure manuals pertinent to… more
- Trinity Health (Livonia, MI)
- …data and ensure charges/coding are in alignment within AMA and Medicare coding guidelines. Ensures medical documentation and coding compliance with Federal, ... productivity standards Maintains compliance with regulatory requirements Assist Nurse Auditor and/or Coordinator with denial coordination process; including analysis… more