Receives, documents, and monitors regulatory guidance from governmental and commercial payers. Coordinates required change to ensure that MPBS systems and practices adhere to all specifications while maintaining revenue cycle optimization. Facilitates MPBS response to audit inquiries. Develops educational materials and programs to promote client provider accuracy and comp

Conducts independent reviews/audits on the adequacy of medical record documentation to support the codes selected by providers or by billing office coders. Verifies and corrects as necessary, the audit work completed by the Compliance Auditors or other Sr. Auditors/Trainers. Analyzes documentation or coding patterns by a provider, division or department that poses a compl

Perform risk assessments of business activities and perform relevant testing based on the risks and processes associated with the area being audited. Assist in communicating issues, risks and recommendations to all levels of management. Operate independently and ensure work is completed to schedule and meets our high quality standards. Develop and maintain strong and effe

Contributes to the achievement of established department goals and objectives, and adheres to IA department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations. Embodies and demonstrates the Mission, Vision and Spirit Values of MedStar. Analyzes findings to identify root causes. Communicates ideas appropri

Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations. Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings serves on committees, and represents

Reviews clinical documentation to determine if charging for the procedure, supplies, implants, recovery, and any other associated charges are documented accurately. Reviews monthly spend while identifying opportunities to reduce expense. Participates in the process of assigning and reviewing HCPC and charge codes assigned to implants and supplies. Reviews OR records for u

Center 1 (19052), United States of America, McLean, Virginia Principal Auditor, Finance (Hybrid) Capital One is seeking an energetic, self motivated Principal Auditor who will assist in the development and execution of the audit plans for assurance coverage of Capital One's Finance business. As a member of the Finance Audit team, the candidate will primarily focus on audit

West Creek 7 (12077), United States of America, Richmond, Virginia Senior Auditor (Hybrid) Capital One's Audit function is a dedicated group of professionals focused on delivering top quality assurance services to the organization's Audit Committee. Audit professionals are experienced, well trained and credentialed, and operate within a collaborative, agile environment to

Design and perform relevant control testing based on the risks and processes associated with the area being audited. Assist in communicating issues, risks and recommendations to all levels of management. Operate independently and ensure work is completed to schedule and meets our high quality standards. Develop and maintain strong and effective working relationships with

Lead small audits, or own completion of significant components of larger audits. Develop engagement planning documentation for assigned areas to communicate rationale for scoping decisions, and develop audit programs to ensure adequate coverage of risks. Design and execute appropriate audit procedures to verify the effectiveness of internal controls. Document auditee proc

Requisition # 625171 Location Johns Hopkins Health Plans, Hanover, MD 21076 Category Non Clinical Professional Schedule Day Shift Who you are As the Vendor Auditor for Johns Hopkins Health Plans ("JHHP"), your in depth knowledge of auditing, claims, and medical policy helps ensure that our vendors are performing to policy and regulations. Not only will you lead audits, yo

Under general supervision, ensures that compliance initiatives are met for all the University of Maryland Medical System (UMMS) Member Organizations. Reviews and analyzes claims data, medical records, and billing and payment information to determine if charges and reimbursement are supported according to federal and state program guidelines. Significant contributor in the

Trains and supervises staff auditors Prepares all planning for engagements, including reviewing PBC lists, preliminary financial statements, engagement budgets and client board notes; participates in the planning meetings prior to fieldwork with Staff, Managers and Partners Manages fieldwork and reviews reports Monitors budgets on a daily basis in the field and communicat

Assessor Staff must hold in good standing at least one (1) of the following IT Professional Certifications (or equivalent) o GIAC Systems and Network Auditor (" GSNA ") o ISC2 Certified Authorization Professional (" CAP ") o ISC2 Certified Information System Security Professional (" CISSP ") o ISACA Certified Information System Auditor (" CISA ")

Oversee the coordinating, reporting, and supervising the testing of ICFR and ITGC controls with ICFR impact Oversee all non IT related risk functions within regulatory and financial (ICFR) risk domains Liaise with Enterprise Risk Management, Finance Risk Management, external and internal auditors, legal, regulatory compliance, and policy regarding ITGC with ICFR and ICFR