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The Senior DME billing code compliance and appeals specialist will play a crucial role in ensuring that our DME product complies with the billing codes and regulations set by Medicare and all federally funded payers.
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Experience appearing before courts, governmental administrative agencies and/or alternative dispute resolution forums, and working on all aspects of litigation matters from case inception to judgment and appeals.
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Here, you'll work alongside approximately 200 other professionals who practice in areas such as government contracts, corporate law, mergers and acquisitions, securities, public finance, real estate, political law compliance, labor and employment, ERISA, real estate, litigation, appeals, and class actions.
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Collaborate with the Executive Director and Manager of Development & Fundraising to identify foundation funding opportunities, prepare grant proposals, and participate in appeals to donors. ● At least two years of relevant legal experience, such as in-house or government practice or practice in employment, disability-related, corporate, real estate, regulatory, or insurance law at a firm.
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Additional responsibilities include supporting pre-or post-payment coding audit for benchmark and/or reimbursement recovery, and other coding-related activities such as pre-appointment chart audits for HCC or risk adjustment, appeals of denied claims, providing information or education to providers for specificity of documentation to align with the coding guidelines to comply with federal, state, and regulatory requirements.
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The UMQM Nurse shall also participate in Utilization Management related activities with the Appeals and Grievance Department as well as the Compliance Department to assure that the quality compliance is being met for NCQA, state and federal regulatory requirements.
Full-timeRemoteExpandApply NowActive JobUpdated 13 days ago - UpvoteDownvoteShare Job
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Gathers pertinent information regarding the grievances and appeals received, including, but not limited to, member or provider concerns, supporting information related to initial decision-making, new information supporting the grievance or appeal, or supplemental information required to evaluate grievances and appeals within regulatory requirements.
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This attorney’s primary role will be to serve as litigation counsel to the Colorado Division of Securities, although the attorney will also gain valuable experience serving as general counsel for various securities and financial services regulatory boards.
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Natixis is looking for an experienced attorney to join the Legal Department to provide legal and regulatory advice with respect to structured note issuances, treasury products, equity derivatives activities, proprietary indices, financial engineering matters, as well as repo and securities lending activities within the Corporate and Investment Banking division.
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Evaluate existing sewage disposal and water treatment installations and facilities for regulatory compliance; evaluate need for expansion or replacement of treatment systems; evaluate well sites and well construction for code compliance and acceptance as domestic water supply; and test and assess public drinking water potability.
$39.79 - $49.7 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Assist in the development of internal physician advisors and provide support in developing solutions for complex cases, in the authorization and denial of services, and in the grievance and appeals process.
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Conduct plan checks of new or remodel construction plans for restaurant, pool and spa facilities, and hazardous materials storage and monitoring systems relative to regulatory compliance; investigate complaints about sewage and various public health nuisances; conduct epidemiological investigations; handle housing and vector complaints; and investigate food borne illnesses.
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If acting in the capacity as a clinical pharmacist the incumbent may also review UM requests; provide consultation into the case and disease management identification process, and consult with the Organization's Associate Medical Directors and Medical Directors when appropriate, follow-up on appeals in accordance with our regulatory guidelines.
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The incumbentassists operations/programs to comply with accreditation and regulatory standards, including but not limited to NCQA, Pennsylvania Department of Health regulations, Department of Public Welfare, CMS, Highmark Wholecare corporate and medical policies.
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These include physicians, practice administrators, specialists, behavioral health providers, ancillary service providers, hospital executives and senior management, various Highmark Wholecare accounts, regulatory agencies, and vendor providers.
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appeals regulatory jobs
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