- Sunrise Senior Living (Haverford, PA)
- …follows Resident Centered Care model. + Assists with case management of both Medicare and non- Medicare guests/residents as needed. + Participates in the Care ... and other test results and communicates appropriately. **Quality Assurance, Regulatory Compliance ** + Strives for excellent quality care and service delivery as… more
- Houston Methodist (Sugar Land, TX)
- …continued stay and resource use, appropriate level of care and program compliance . Identifies when services no longer meet InterQual/Milliman l criteria, initiates ... if needed, and informs management of the possible need for issuing Medicare Hospital Initiated Notice of Non-coverage. + Applies approved utilization criteria to… more
- Houston Methodist (Houston, TX)
- …care payers include commercial payers, separate transplant contracts, Medicare Advantage, Medicaid Health Maintenance Organizations (HMOs), International, behavioral ... for employee engagement, adequate staffing levels, budget development and compliance , staffing decisions such as hiring and terminating employment, coaching… more
- Houston Methodist (Nassau Bay, TX)
- …continued stay and resource use, appropriate level of care and program compliance . Identifies when services no longer meet InterQual/Millman l criteria, initiates ... if needed, and informs management of the possible need for issuing Medicare Hospital Initiated Notice of Non-coverage. + Applies approved utilization criteria to… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …you'll play a critical role in ensuring the accuracy, completeness, and compliance of risk adjustment coding across both internal teams and external partners. ... our healthcare data. Your Responsibilities * Ensure accuracy and compliance of risk adjustment coding, including the appropriate coding...* Experience in medical coding with a focus on Medicare Advantage and ACA risk adjustment. * Certified Risk… more
- LA Care Health Plan (Los Angeles, CA)
- …Health Plans Auditor III Claims Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... execution, reporting and corrective action plans monitoring of claims processing compliance for specialty health plans and vendors. This includes medical, vision,… more
- Sunrise Senior Living (Charlottesville, VA)
- …(RAI) process. + Reviews and assists in case management of both Medicare & non- Medicare guests/residents. + Ensures interdisciplinary notes reflect the ... General Safety** + Partners with community team to ensure community is in compliance with OSHA requirements and promotion of Risk Management programs and policies… more
- Mount Sinai Health System (New York, NY)
- …CDM Chargemaster with strong medical coding expertise to support the maintenance, compliance , and optimization of the hospital Charge Description Master (CDM). The ... equivalent credential required + Proficient in CPT, HCPCS, revenue codes, and Medicare billing regulations. + Advanced proficiency in Epic, especially in EAP… more
- Covenant Health Inc. (Knoxville, TN)
- …Business Office ("CBO"), charge capture / coding, working closely with the CMG compliance officer, and the centralized coding group . Recruiter: Suzie McGuinn || ... ensure that any claims are reprocessed and any refunds are made in compliance with current rules and regulations. + Works closely with Covenant's Vice-President and… more
- Amazon (San Francisco, CA)
- …Amazon One Medical. This includes developing and refining programs, ensuring compliance with state and federal requirements, and fostering collaboration among ... across the organization. You will effectively manage projects that ensure compliance with evidence-based practice, regulatory standards, and our standard work. Key… more