• Medicare Pharmacy Audit Programs…

    CVS Health (Scottsdale, AZ)
    …In this role, you will be expected to familiarize yourself with all the Medicare Audit Programs and become a subject-matter-expert on assigned audit ... each year, you will be expected to develop solutions to flexibly adapt the Medicare Audit Programs to comply with the new requirements and new programs. You must… more
    CVS Health (04/25/25)
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  • Associate Compliance Officer (ACO) Clinical…

    Nuvance Health (Danbury, CT)
    …supporting Compliance throughout the Network; 6.Performs payer audits, applying appropriate Medicare , Medicaid guidelines. Conducts post audit exit conference, ... skills, presentation skills, a strong knowledge base in: of clinical audit , clinical record documentation, Medicare Conditions of Participation; and… more
    Nuvance Health (04/17/25)
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  • Audit & Reimbursement III

    Elevance Health (East Syracuse, NY)
    …Requirements:** + Requires a BA/BS degree and a minimum of 5 years of audit /reimbursement or related Medicare experience; or any combination of education and ... ** Audit & Reimbursement III** **Location** : **Virtual:** This...Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare more
    Elevance Health (05/09/25)
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  • Certified Pharmacy Technician, Specialty/Home…

    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
    Walmart (04/30/25)
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  • Coordinator, Graduate Medical Ed (GME) Program

    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
    Charter Care Health Partners (04/12/25)
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  • Coordinator-RAC TPE

    Baptist Memorial (Memphis, TN)
    …PREFERRED 5 years of healthcare care experience and 3 years in Medicare billing environment. Previous audit experience, knowledge of InterQual and ... TPE Job Code: 21540 FLSA Status Job Family: FINANCE Job Summary Medicare / Medicaid Appeals Registered Nurse reviews and evaluates medical documentation to… more
    Baptist Memorial (04/12/25)
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  • Senior Compliance Professional - Specialty…

    Humana (Providence, RI)
    …focus on Medicare Supplement plans. + Complete risk assessments, develop audit methodology and perform auditing and monitoring activities to prevent and detect ... to the administration of Specialty products with a focus on Medicare Supplement plans. The Senior Compliance Professional's work assignments involve moderately… more
    Humana (05/14/25)
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  • Medicare Biller / Accounts Receivable

    CommuniCare Health Services Corporate (Indianapolis, IN)
    Medicare Biller The CommuniCare Family of Companies currently owns/manages over 130 World-Class Nursing and Rehabilitation Centers, Specialty Care Centers, and ... living communities. CommuniCare Health Services is currently recruiting a Medicare Biller for our Central Billing Office in Cincinnati,...+ Verify receipt of monthly triple check forms and audit for accuracy per triple check policy prior to… more
    CommuniCare Health Services Corporate (05/19/25)
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  • Billing Follow Up Medicare

    Chesapeake Regional Healthcare (Chesapeake, VA)
    The Medicare Billing and Follow-up Representative are responsible for the compliant, accurate and timely billing and follow-up of all hospital Medicare and ... limited as other tasks may be assigned. + Submit Medicare / Medicare Advantage plan claims both electronic and...of complex scenarios such as interim , self - audit , combined , and split billing etc. +… more
    Chesapeake Regional Healthcare (03/28/25)
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  • HIM Audit and Education Specialist

    Hartford HealthCare (Farmington, CT)
    …programs and other common practices across the system. *_Position Summary:_* The Audit & Education Specialist develops and implements an effective and comprehensive ... audit & education program for coding consistent with regulatory,...4. Researches literature from regulatory groups such as; HHS/OIG, Medicare , Medicaid, NGS, etc., professional and peer organizations' practices/policies/guidelines… more
    Hartford HealthCare (04/24/25)
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