We are, at heart, a construction company with an aim to provide top level services to our clients in high tech and challenging industries.
We are, at heart, a construction company with an aim to provide top level services to our clients in high tech and challenging industries.
Genesis is one of the nation\'s leading providers of post-acute healthcare services from short-term to long-term care and a wide variety of living options and professional clinical services.
LOCATION 60 Newport Ave. Route 1 02916 Overview
LOCATION 60 Newport Ave. Route 1 02916 Overview
Partners with their assigned Line of Business, other Risk/Compliance/Audit (RCA) professionals, and RCA Managers to, depending on their function, create, implement, maintain, review or oversee an effective risk management framework. Participates in projects and/or activities that ensure compliance with applicable federal, state and local laws and regulations. Identifies gaps and inform solutions that minimize losses resulting from inadequate internal processes, systems or human errors. Identifies, responds and/or escalates risks as appropriate. Serves as a functional liaison between the Line of Business and the Lines of Defense.
Job Description
Job Description
Job Description
Senior Recovery Auditor Full Time Job ID 892 Job DescriptionConduct complex, in-depth claim and data analysis of all claims payments, identifying trends and patterns to ascertain overpayment recovery potential. Ensure medical claims, medical records, and other documentation essential to claims submission and reimbursement are in compliance with state and federal guidelines, provider contracts, BCBSRI policy, national coding guidelines, and industry standards. Detect areas of billing inefficiencies, internal control weaknesses, and noncompliance and provide recommendations for corrective action plans.ESSENTIAL JOB FUNCTIONS:Conduct a thorough analysis of all medical claims for adherence to state and federal guidelines, provider contracts, BCBSRI policy, national coding guidelines, and industry standards.Review, research, and interpret medical record documentation, claims data, contractual guidelines, payment methodologies, and system adjudication to identify trends and patterns in complex claims payment data that result in recovery opportunities.Provide data, reimbursement analysis, and recommendations to management on all department non-compliant findings affecting reimbursement, including policy, contract issues, provider errors, pricing, systems, and claim processes.Perform audit peer review analysis for Audit Coordinator and Medical Claims Recovery Auditors periodically to ensure quality of results and consistency in content, analytics, and adherence to department policies and procedures.Develop written reports in accordance with reporting standards. Ensure that all audit findings, exceptions, and proposed adjustments to work papers are well defined and explained or included in reports.Provide guidance to auditors assigned to data. Provide on-the-job training and feedback throughout the reviews.Develop repayment plans with providers when necessary based on financial impact, scope of audit findings, and audit resolution.Manage appeals process with providers and third-party arbitrators. Forward pertinent documentation to arbitrator and advise provider of decision. The impact of the decision is reflected in the audit adjustment report and settlement process.Mentor less experienced staff.Lead department projects and initiatives.Perform other duties as assigned.QUALIFICATIONS: Minimum Education and Experience: Bachelor\'s degree in Business, Finance, Computer Science, Mathematics, Statistics, or related field; or an equivalent combination of education and experience.Coding certification (CPC, CCS, CPMA, or equivalent).Five-plus years of experience in medical claims review or claims processing.Five-plus years of experience in quantitative or statistical analysis (preferably in healthcare).Experience using PC SAS (preferably Enterprise Guide SAS), Crystal, and/or Business Objects.Proven analytic expertise using Microsoft Excel and database query capabilities and ability to evaluate data at all levels of detail.Preferred Education, Additional Qualifications, and Experience:Superior knowledge of diagnostic-related groups (DRG) and American Hospital Association Official Coding Guidelines.Familiarity and ability to interpret hospital/provider contracts.Familiarity with medical claims reimbursement.Financial/accounting methodology exposure.Required Knowledge, Skills, and/or Abilities:Knowledge of medical claims data.Knowledge of managed care practices.Knowledge of Correct Coding Initiative (CCI) guidelines.Demonstrated ability to constructively and sensitively provide feedback to providers regarding federal and state coding, medical documentation and compliance guidelines, audit results, and risk areas.Audit skills and the ability to interpret and apply federal and state regulations and coding and billing requirements.Demonstrated ability to review analytical, data, and audit findings to identify coding trends and risk areas.Ability to interpret contract reimbursement schedules and policies.Strategic and critical thinkin
Job Title: Mechanical/Structural Engineer| Location: Middletown, Rhode IslandPurvis is seeking a Mechanical Engineer for a full-time position.Description of Work: The Mechanical Engineer will work as a member of the design engineering team to provide technical support to Navy programs with primary responsibilities to include:Performing stress analysis, weight and moment, center of gravity and hydrodynamic calculationsEvaluate mechanical designs for deficiencies and provide feedback to designers as necessaryAssist with analyzing documentation for equipment installed using alteration packages onboard submarinesWork closely with the design and installation teams.Required Qualifications:Bachelors degree in Mechanical Engineering or equivalent1 4 years professional experience in mechanical/structural designCandidate must have or be able to obtain a government security clearance to the level of SECRETProficient in AutoCAD, Solidworks, and MathCAD software, drafting standards and practices, as well as Microsoft Office programs.Preferred Qualifications:Knowledge of submarines, DoD specifications, and 3D modelingExperience with shock design and analysis, Finite Element Analysis (FEA), and Dynamic Design Analysis Method (DDAM).
We are, at heart, a construction company with an aim to provide top level services to our clients in high tech and challenging industries.
We are, at heart, a construction company with an aim to provide top level services to our clients in high tech and challenging industries.
Job Number 19131679
Job Number 19131679
Primary Duties & Responsibilities:
We are, at heart, a construction company with an aim to provide top level services to our clients in high tech and challenging industries.
We are, at heart, a construction company with an aim to provide top level services to our clients in high tech and challenging industries.
Location
CNC Machinist
Janssen Research & Development, part of the Johnson & Johnson Family of Companies is recruiting for a Senior Statistical Programmer, Oncology located in Raritan, NJ, Titusville, NJ or Spring House, PA with consideration given to other US or Canada locations.
We are, at heart, a construction company with an aim to provide top level services to our clients in high tech and challenging industries.
Bus Info Developer or Developer Senior-PS27987
Program Administrator/Survey Management(PS27956)
Full Stack Java Developer
We are, at heart, a construction company with an aim to provide top level services to our clients in high tech and challenging industries.
Medical Records Coordinator team members assist with ensuring the health and well-being of our residents by being responsible for all administrative tasks associated with medical records of residents. Certification is preferred but not required.
Do you view data as an art and a science? So do we.
Janssen Research & Development, LLC, a member of Johnson & Johnson\'s Family of Companies, is recruiting for a Senior Local Trial Manager supporting the Oncology, Medical Affairs and Pulmonary Arterial Hypertension Therapeutic Areas. This position can be located remotely within the United States.
Janssen Research & Development, LLC, a member of Johnson & Johnson\'s Family of Companies, is recruiting for a Senior Local Trial Manager supporting the Oncology, Medical Affairs and Pulmonary Arterial Hypertension Therapeutic Areas. This position can be located remotely within the United States.
Bookseller - Part-Time
Description
We are, at heart, a construction company with an aim to provide top level services to our clients in high tech and challenging industries.
Description
Program Administrator- Process Improvement/Implementations (PS27725) Any Anthem office
Job Number 19129877
We are, at heart, a construction company with an aim to provide top level services to our clients in high tech and challenging industries.
We are, at heart, a construction company with an aim to provide top level services to our clients in high tech and challenging industries.
Job Description:
Provider Reimbursement Admin - PS27676
Vehicle Fleet Administrator North Carolina (PS27167)
Provider Reimbursement Admin Sr. - remote PS27757
Provider Clinical Liaison -Memphis, TN- PS27736
We are, at heart, a construction company with an aim to provide top level services to our clients in high tech and challenging industries.
Genesis is one of the nation\'s leading providers of post-acute healthcare services from short-term to long-term care and a wide variety of living options and professional clinical services. We are changing how care is delivered by bringing together people like you passionate - highly skilled and motivated to make a difference.
Bookkeeper
Medical Assembler- 2nd Shift
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