- Rochester Regional Health (Rochester, NY)
- …Info> RESPONSIBILITIES: + Program & Budget Management. Maintain knowledge of Medicare eligibility requirements and provide assistance in the decision making of ... department budget; assists in monitoring and controlling budget variances; assure compliance with charting requirements in the electronic medical record + Staffing.… more
- Amgen (Thousand Oaks, CA)
- …enforcement, advising and managing commercial dispute resolution + Supporting healthcare compliance related matters as they relate to implementation of pricing ... including counseling on: + Healthcare fraud and abuse matters + OIG compliance guidance and advisory opinions + DOJ settlements with pharmaceutical industry +… more
- Sutter Health (Emeryville, CA)
- …best practices, level of care progression, denial management and compliance with governmental regulations and conditions of participation and commercial ... in the appropriate level of care with supporting documentation of regulatory compliance and accurate coding. The Physician Advisor (PA) conducts clinical reviews on… more
- Spira Care, LLC (Overland Park, KS)
- …and learning style. + Maintains confidentiality of all regulated information in compliance with state and federal laws. Reads, understands and follows medical policy ... agreed to by leadership to maximize program value; ensures compliance with applicable URAC and NCQA accreditation guidelines and...(PCF) model + Understanding of Affordable Care Act and Medicare /CMS + Thorough knowledge of URAC and NCQA guidelines… more
- Erickson Living (Springfield, VA)
- …across the Erickson Senior Living community continuum of care + Following Medicare , state and federal regulations, APTA, and company policies and procedures and ... ensure departmental understanding and compliance in the areas of care provision, documentation, billing reimbursement, resident rights, customer service, and … more
- Heath System Services (Niagara Falls, NY)
- …timely and accurate handling of incoming orders. + Billing and Insurance Compliance : + Ensure all orders meet payer requirements, including benefit verification, ... medical necessity qualification, and prior authorization. + Maintain adherence to Medicare , Medicaid, and commercial payer standards. + Act as a resource for billing… more
- CVS Health (Hartford, CT)
- …jurisdictions. The analyst collaborates closely with investigative teams, legal, compliance , and operational departments to maintain transparency and accountability ... **Required Qualifications** + 5+ years of experience in healthcare investigations, compliance , or data analysis (or equivalent professional experience) + Strong… more
- HCA Healthcare (Dallas, TX)
- …and facility processes. . Prepares documentation for Notification of Non-covered Medicare Services or Advance Beneficiary notices to patients and follows practice ... . Supports and adheres to HCA Code of Conduct, related Ethics and Compliance policies, and HIPAA requirements. . Supports and adheres to personnel policies and… more
- City of Alpharetta, Georgia (Alpharetta, GA)
- …by Employee Manual & Benefits Handbook or bona fide occupational qualifications). In compliance with the Drug-Free Workplace Act of 1988, the City of Alpharetta is ... successfully perform the essential functions of this job. In compliance with the ADA, the City of Alpharetta will...yrs. of service) may continue individual coverage up until Medicare eligibility at age 65. Medical Reimbursement: retirees (age… more
- WMCHealth (Hawthorne, NY)
- …the appropriate write-off codes + Monitors any denial vendor relationships for compliance and performance, and suggests modifications to Revenue Cycle leadership as ... necessary + Monitors contract compliance and escalates to Managed Care staff as needed...Demonstrated knowledge of healthcare management, collections management, Medicaid and Medicare . + Experience in establishing and managing claim denial… more