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Operational Auditor
2 weeks ago
InsideHigherEd Raleigh, United StatesPosting Number:PG193393EP · Internal Recruitment :No · Working Title:Operational Auditor - Advanced · Anticipated Hiring Range:Commensurate with education and experience · Work Schedule:Monday - Friday 8am-5pm; hybrid with some flexibility · Job Location:Raleigh, NC · Department ...
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IT - Cyber Security Specialist
2 weeks ago
eTeam Inc Raleigh, United StatesJob Description: CSOC-Tier 3 Analyst · Key Responsibilities: · Candidate will support the mission of the Threat Intelligence Unit by analyzing and tracking adversaries, creating and sharing intelligence both internal and external to CISO, and creating and updating cyber threat pr ...
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Tax Accountant
2 weeks ago
Regal Executive Search Raleigh, United StatesJob DescriptionTax Accountant (State & Local) · Position Purpose: · Assist with the preparation of state income, local income, and franchise tax returns, including estimated tax payments and extension calculations. · Assist with the preparation of the quarterly and annual ASC ...
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Audit Director Technology Cyber
6 days ago
Truist Raleigh, United States Full timeESSENTIAL DUTIES AND RESPONSIBILITIES · Charlotte NC - 214 North Tryon Street · Raleigh NC Beechleaf Court · Atlanta, GA - 303 Peachtree Street · Winston Salem, NC - 101 North Cherry Street · Richmond, VA.-1001 Semmes Ave. · This is not a remote position; we require candidates to ...
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Accountant - External Reporting
2 weeks ago
Advance Auto Parts Raleigh, United StatesJob Description · Summary: Applies principles of accounting to analyze financial information, record and reconcile transactions, assist in the preparation of financial reports, calculates incentives and disputes arise with the vendors, ensures the Company's inventory transaction ...
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Financial Compliance Auditor
2 weeks ago
InsideHigherEd Raleigh, United States Administrative Jobs ,Posting Number:PG193391EP · Internal Recruitment :No · Working Title:Financial Compliance Auditor · Anticipated Hiring Range:Commensurate with Experience and Education ($70,000-$90,000) · Work Schedule:Monday through Friday 8-5 · Job Location:Raleigh, NC · Department :Foundations ...
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General Ledger Accountant
4 weeks ago
Rose International Raleigh, United StatesDate Posted: 05/06/2024 · Hiring Organization: Rose International · Position Number: 463506 · Job Title: General Ledger Accountant · Job Location: Raleigh, NC, USA, 27609 · Work Model: Hybrid · Shift: 3 days onsite · Employment Type: Temporary · Estimated Duration (In months): 8 ...
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Payroll Manager
2 weeks ago
Capitol Broadcasting Company Raleigh, United StatesDescription · Capitol Broadcasting Company is seeking a new Payroll Manager. This person will oversee and supervise the organization's payroll functions, ensuring pay is processed on time, accurately, and in compliance with government regulations. You will work closely with all ...
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Senior Staff Accountant
2 weeks ago
FMIC Insurance Agency Inc. Raleigh, United StatesJob Description · Job Description · Benefits:401(k)401(k) matchingDental insuranceHealth insurancePaid time offVision insurance · Summary:The Senior Staff Accountant is responsible for preparing and maintaining analysis and reporting of organizations financials to reduce costs ...
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PNC Bank NA Raleigh, United States Full timeDescription · Provides and may lead a variety of financial management and accounting services. · Prepares internal financial and business metric reports and provides information to support quarterly and annual external reports. · Leads annual budget process and monthly forecast ...
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Internal Audit Director
3 days ago
PNC Bank NA Raleigh, United States Full timeDescription · Evaluates organizational business risks; develops and communicates audit plan; and oversees execution of audits. Partners with the business on audit execution and results, serving as the relationship manager between audit and the business. · Coordinates/monitors/re ...
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Auditor
6 days ago
State Employees' Credit Union Raleigh, United States Full timeIf you are motivated and believe in the credit union philosophy of "People Helping People," join our team · Position Overview: · To assist in the development, completion and documentation of risk-based internal audit assurance activites including financial, operational and compli ...
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Lead Sterile Processing Technician
1 week ago
Duke University Raleigh, United StatesAt Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. · About Duke Raleigh Hospital, A Campus ...
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Financial Compliance Auditor
2 weeks ago
NC State University Raleigh, United StatesPlease see Special Instructions for more details. · Please include a cover letter, resume and contact information for three professional references.Posting InformationPosting NumberPosting Number · PG193391EPInternal RecruitmentInternal Recruitment · NoWorking TitleWorking Tit ...
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Energy Engineer
1 week ago
InsideHigherEd Raleigh, United StatesPosting Number:PG193343EP · Internal Recruitment :No · Working Title:Energy Engineer · Anticipated Hiring Range:$80,000 - $86,872 · Work Schedule:Monday - Friday, 7:00 am - 4:00 pm; with some flexible/remote work capability · Job Location:Raleigh, NC · Department :Energy Manageme ...
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Assistant Director of Financial Aid
2 weeks ago
William Pace University Raleigh, United StatesThe Assistant Director of Financial Aid will support financial aid operations in all aspects of the application, awarding, delivery, and reconciliation of federal, state, and institutional financial aid in accordance with all policies, procedures, an Director, Financial, Assistan ...
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Operational Auditor
1 week ago
North Carolina State University Raleigh, United StatesNC State University is a Research I land-grant University with a $1.714 billion budget for fiscal year 2020, a $1.4 billion endowment, over 36,000 students, and almost 10,000 faculty and staff state-wide. The Internal Audit Division's (IAD) mission is to support the University's ...
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Clinical Auditor RN Revenue Intergrity
3 weeks ago
WakeMed Raleigh, United StatesAbout WakeMed:Serving the community since 1961, WakeMed Health & Hospitals is the leading provider of health services in Wake County. With a mission to improve the health and well-being of our community, we are committed to providing outstanding and compassionate care. For more i ...
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Tax Auditor Motor Fuels
2 weeks ago
State of North Carolina Raleigh, United StatesThis position has been established as hybrid teleworking. · The North Carolina Department of Revenue is currently seeking a Revenue Tax Auditor I to work out of the Raleigh Service Center in the Motor Fuels Section of the Examination Division. The Motor Fuels Section administers ...
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Certified Trainer
2 weeks ago
Mastech Digital Raleigh, United StatesJob Description · Job DescriptionMastech Digital provides digital and mainstream technology staff as well as Digital Transformation Services for all American Corporations. We are currently seeking a Certified Trainer for our client in the Consulting domain. We value our professio ...
Risk Adjustment Auditor Educator - Raleigh, United States - Centene Corporation
Description
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, youll have access to competitive benefits including a fresh perspective on workplace flexibility.
**Position Purpose:** Conduct provider medical record audits, analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment and improve quality of care. Analysis of MRA data to identify patterns and development of interventions at the provider and market level.
+ Subject matter experts for proper risk adjustment coding and CMS data validation.
+ Work in conjunction with other departments to include Provider Relations, Quality as well as the Medical Director for the state assigned to ensure compliance of CMS risk adjustments guidelines are met.
+ Analyze MRA data to identify patterns and development of interventions at the provider and market level to coordinate an educational work plan for WellCare contracted providers.
+ Conduct provider education and training regarding risk adjustment to help to ensure accurate CMS payment and to improve quality of care.
+ This includes training venues such as provider offices, hospitals, webinars, conference calls, email correspondence, etc.
+ Works on additional risk adjustment audit requests (i.e. outside auditors requests).
+ Serves on the RADV Committee as subject matter experts.
+ Perform quality assurance auditing (i.e. ensure appropriateness and accuracy of ICD-9/ICD-10 coding) for WellCares Medical Coding Specialists.
+ Communicates QA results to the Medical Coding Specialists with suggestions for improvement and re-training topics.
+ Perform other duties as necessary.
+ Complies with all policies and standards.
**Education/Experience:** Bachelors degree or equivalent experience required.
**Candidate Experience:** Required 5+ years of experience in a hospital, a physician setting or a Managed Care Organization as a medical coder.
Required 2+ years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding).
Required Other experience in teaching, training or an educator/instructor role required; but provider education experience is preferred.
Preferred Other managed care experience.
**Licenses and Certifications:** A license in one of the following is required:
**One of the following licensures required at hire:** CPC or CCS
CRC required within the 1st year of employment.
CPMA preferred on the 2nd year of employment.
Pay Range: $54, $97,100.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
