- Robert Half Office Team (Los Angeles, CA)
- …required for travel to onsite audits. + 1-3 years of experience in credentialing or Medicare audit functions. + At least 2 years of direct experience conducting ... to ensure continued compliance with contractual and regulatory requirements. + Audit internal credentialing processes to ensure compliance with CMS (Centers for… more
- Elevance Health (St. Louis, MO)
- … Medicare and Medicaid Services to transform federal health programs. The ** Audit and Reimbursement Senior** will support our Medicare Administrative Contract ... + Requires a BA/BS and a minimum of 8 years of audit /reimbursement or related Medicare experience; or any combination of education and experience which would… more
- Robert Half Office Team (Monterey Park, CA)
- … audit work. + One (1) to three (3) years of experience in credentialing or Medicare audit roles required. + A minimum of two (2) years of experience in ... Develop, implement, and manage corrective action plans to address audit findings. + Monitor, analyze, and report data to...audit processes is necessary. + Advanced knowledge of Medicare Advantage CMS and California DMHC regulations. + In-depth… more
- Walmart (Orlando, FL)
- …process Medicare orders to ensure compliance; and interpreting and documenting Medicare audit documents. + Ensures fulfillment of pharmacy prescriptions in a ... documentation; and maintaining a safe and clean work environment. + Complies with Medicare and Medicaid policies and procedures by implementing and adhering to rules… more
- Charter Care Health Partners (Providence, RI)
- …year; submit executive summary and action plan to the GME Office + Prepare Medicare Audit documents, per the GME Office's instructions + Manage fellow financial ... program's New Fellow Orientation (print documents, etc.) + Research forms for Medicare reimbursements for fellowships with dedicated research time, if applicable +… more
- 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 sufficiently… more
- WelbeHealth (Boston, MA)
- …growth drivers + Assist with month-end close, quarterly financial reporting, financial audit , Medicare /Medicaid audits, and other PACE specific projects + Keep ... payment model, including ability to track and analyze revenue streams (eg Medicare , Medicaid, Part D) along with PACE rates and regulatory constructs **Job… more
- Dignity Health (Phoenix, AZ)
- …and importance of accurate HCC recapture and RAF scoring. - Assistance in the Medicare QRDA quality audit and file submission. - Leading of practice meetings ... performance in value based contracts (CMS ACO, HEDIS, NCQA, etc.) and Medicare Advantage programs (HCC/RAF). In addition these positions also support our clinicians… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …exposure to all areas of BCBSMA, with a focus on senior product strategy and Medicare Markets. This candidate must be a creative thinker with the ability to drive ... collaboratively with both technical and non-technical staff including Underwriting, Medicare Product Development, Provider Contracting, Sales, and others across the… more
- Molina Healthcare (St. Petersburg, FL)
- …Summary** Responsible for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for reviewing and ... accordance with the standards and requirements established by the Centers for Medicare and Medicaid. This position will provide direct support to the implementation… more