- Emory Healthcare/Emory University (Atlanta, GA)
- …Council. + Primary duties and responsibilities: Participates in external reviews such as Medicare Recovery Audit Program or other third-party audit ... programs and defends Emory Healthcares decisions as appropriate through written appeals as needed. + Conducts complete and accurate retrospective reviews and audits of hospital records to determine if patient class (level of care) was appropriate and… more
- CVS Health (Scottsdale, AZ)
- …strategic response development based on in-depth experience regarding specific pharmacy audit , contract, credentialing and financial recovery questions and ... to contract depository retrieval, pharmacy credentialing/recredentialing, pricing/rates, pharmacy audits, post- audit activities and recoveries, and associated state/federal regulations governing… more
- State of Colorado (Denver, CO)
- …Provider Payment Reviews + Fraud Investigation + Waste and abuse reviews and recoveries + Recovery Audit Contract (RAC) + Data analytics and data mining for FWA ... Office of the Inspector General (OIG), the Centers for Medicare and Medicaid (CMS), US Attorney's Office, United States...Investigation + Waste and abuse reviews and recoveries + Recovery Audit Contract (RAC) + Data analytics… more
- Penn Medicine (Bala Cynwyd, PA)
- …related, but not limited to, Office of the Inspector General (OIG), Recovery Audit Contractors (RAC), Medicaid Integrity Contractors (MIC), Zone Program ... Appeals is responsible for the daily management and tracking of Government audit activity received by Penn hospitals, provider groups and alternative care settings.… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …protocols which align with Bon Secours Mercy Health's overall compliance audit and compliance responsibilities relative to hospital revenue cycle services performed ... procedures for the development of compliance internal monitors and audit protocols and the prevention of fraud, waste and...hospital revenue cycle risk areas highlighted by the OIG, Medicare , State Medicaid, State Insurance Fraud; Managed Care or… more
- Molina Healthcare (Biloxi, MS)
- …solutions. + Manages Scorable Action Items (SAIs) related to pre-pay editing, post-pay audit , and overpayment recovery initiatives to ensure Health Plan SAI ... Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay… more
- NHS Management, LLC (Daytona Beach, FL)
- …offers you the unique opportunity to walk alongside patients on their road to recovery from many different conditions. As you care for and help patients achieve ... with internal controls and state and federal regulations. + Ability to audit resident accounts, assess accuracy and collectability of accounts receivable balances,… more
- Ventura County (Ventura, CA)
- …and other auditors. Oversees audits, interprets and assists with resolution to audit findings. Provides results and responses to State, Federal and/or other ... techniques used, equitable allocation of costs, and maximum cost recovery from State and Federal entities; + Develops charts,...were with Mental Health, Substance Use Services, and/or hospital Medicare /Medi-Cal cost reporting; OR one (1) year as a… more
- Bassett Healthcare (Cooperstown, NY)
- …via mail, phone, or MyBassett to meet patient satisfactions. Takes a lead in service recovery , and acts as a service liaison in the moment. Acts as a trainer for ... is entered or scanned into the system accurately as monitored by system audit Accurate confirmation of attending PCP and Billing PCP, when appropriate. Assures… more
- Molina Healthcare (Idaho Falls, ID)
- …for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. ... coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position...+ Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. + Understanding of… more