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Job Title: Medicare Contractor Medical Director (CMD) – Physical Medicine & Rehabilitation (PM&R Focus) Employment Type: Full-Time Work Environment: Remote with limited travel (approximately 3–4 weeks per year, based on business needs) Position Summary The Medicare Contractor Medical Director (CMD) provides senior-level medical leadership and clinical decision-making in support of the Medicare program and serves as a liaison between healthcare stakeholders and the Centers for Medicare and Medicaid Services (CMS). This role plays a critical part in developing Local Coverage Determinations (LCDs), ensuring compliance with Medicare policies, reviewing complex medical claims, and advancing evidence-based healthcare practices. The position is ideally suited for a board-certified PM&R physician with strong clinical expertise, policy acumen, and a passion for provider education and quality improvement. Essential Duties & Responsibilities Clinical Expertise & Consultation (30%) • Provide leadership in clinical program outreach to practitioners, providers, suppliers, and beneficiaries., • Guide and support clinical staff in provider education initiatives and clinical guideline development., • Maintain current knowledge of medical practice standards and emerging healthcare technologies., • Serve as a subject matter expert in medical and clinical issues relevant to the Medicare population., • Provide clinical consultation to internal teams (medical review, appeals) and external stakeholders., • Apply scientific literature review and claims data analytics to inform medical policy and identify high-risk or problem areas. Collaboration & Leadership (30%) • Collaborate with CMS and other Medicare contractors to develop and update medical policies and coverage articles in accordance with clinical evidence and regulatory requirements., • Work with multidisciplinary teams to improve operational processes and ensure compliance with CMS directives., • Liaise with CMS staff, medical societies, and other stakeholders to align objectives and address emerging issues., • Represent the organization at CMS meetings and professional conferences., • Strengthen quality improvement initiatives with emphasis on decision consistency and clinical staff education, including oversight of Inter-Reviewer Reliability (IRR) activities Program Integrity (20%) • Support program integrity efforts by identifying trends in inappropriate billing or noncompliance., • Ensure correct application of Medicare regulations, National Coverage Determinations (NCDs), LCDs, and clinical guidelines., • Lead all phases of LCD development, including creation, revision, retirement, education, and policy decision-making., • Collaborate with investigative teams and law enforcement when required. Medical Review & Appeals (10%) • Oversee medical review activities to ensure accurate and consistent claim determinations (pre- and post-payment)., • Develop and implement Medical Review Quality Assurance programs and internal review guidelines., • Review complex or high-level appeals and provide expert guidance on Medicare policy application., • Support the appeals process through position paper development and participation in administrative hearings (e.g., ALJ hearings). Provider Education & Communication (10%) • Provide leadership within the provider community, including engagement with hospital and specialty associations., • Educate providers individually and in group settings on medical policies and identified compliance issues., • Maintain strong professional relationships with internal teams and external partners. Required Qualifications • MD or DO degree from an accredited medical school., • Minimum of three (3) years of clinical practice experience as an attending physician., • Extensive knowledge of the Medicare program, including coverage and payment rules., • Experience in health insurance, utilization review, or healthcare claims processing involving development of medical necessity or coverage policies., • Demonstrated ability to evaluate clinical evidence and develop evidence-based medical necessity standards within the Medicare fee-for-service structure., • Basic understanding of medical coding conventions., • Strong communication skills with the ability to educate internal teams and external stakeholders on healthcare policy., • Proven ability to collaborate with clinical and non-clinical staff to assess billing, coding, utilization, and compliance issues., • Public speaking proficiency and experience delivering provider education., • Computer literacy, including word processing, spreadsheets, presentations, and virtual meeting tools., • Ability to complete independent and computer-based training. Licensure & Certification Requirements • Current, active, unrestricted license to practice medicine in at least one U.S. state or territory (never suspended or revoked)., • Eligible for licensure in applicable jurisdictions., • Board Certified (MD or DO) in a specialty recognized by the American Board of Medical Specialties for a minimum of three (3) years. Preferred Qualifications • Board-certified Physical Medicine & Rehabilitation (PM&R) physician with at least five (5) years of clinical practice., • Experience in Internal Medicine, Oncology, Radiology, Ophthalmology, or Infectious Diseases., • MBA, MHA, MS in Management, or formal coursework in healthcare or medical systems management., • Prior Medical Director experience in Medicare or commercial healthcare organizations., • Coding and billing experience using HCPCS, CPT, and ICD-10 codes., • Experience using GRADE methodology and conducting systematic literature reviews., • Leadership experience in organized medicine (e.g., specialty societies, state health departments)., • Experience working with physician groups, beneficiary organizations, or congressional offices. Travel Requirement • Travel within and outside assigned jurisdictions as needed (estimated 3–4 weeks annually, subject to business needs). EOC Ascendo is a certified minority owned staffing firm, and we welcome and celebrate diversity. Ascendo is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, parental status, military service or any other characteristic protected by federal, state or local law

Description Dane Street, a leading national provider of Utilization Review (UR) and Independent Review Organization (IRO) services, is expanding our panel of physician reviewers. We are seeking Board-Certified General Surgeons with an active Louisiana medical license to conduct independent medical reviews on a flexible, fully remote basis.

Mercor is seeking senior attorneys or legal academics to review structured legal content related to special needs planning and disability benefits.Your expertise will ensure legal accuracy and clarity across datasets used for advanced AI evaluation.Key Responsibilities:** - Review legal documents an

Full-Service Reviewer (QA Analyst). On behalf of a leading national restoration company with over 300 franchise locations across North America, we are seeking a highly skilled and analytical Full-Service Reviewer to join their remote Claims Force team. As a Full-Service Reviewer, you will be respons

Job DescriptionDescription: Remote Plan Reviewer JOB DESCRIPTION: Conduct various types of plan reviews remotely. Ensure all work is completed in a timely manner, clients are well supported and clearly communicated with, and maintain a strong focus on helping clients build efficiently and correctly. SUCCESS LOOKS LIKE – Company Wide: • Building Better, • Business can be a powerful force for good in the world, we can and should leverage Legacy to do that in the most effective way possible??, • Team Members: Support the growth of our employees and their families – personally, professionally, financially, etc.??, • Buildings: Help our clients build more efficiently, correctly?? Be The Best: • P x RMA = O, • +1 People, • On Purpose, • Legacy’s Golden Rule, • Good Faith & Fair Dealing, • Perform plan review as scheduled., • Provide clear and accurate feedback to each client., • Communicate each day worked with the Plan Review Administrator project timelines and status updates., • Complete daily timesheets listing each work task performed, time required to complete the task and list any other costs or charges incurred. Email daily timesheet by 6 AM the following workday., • Be on the lookout for work from existing clients and potential clients. Communicate information with department director and marketing lead through CRM and verbally as needed., • Assist with take-offs and proposals as needed. Additional Information:?? In-office Location?? Must maintain an acceptable driving record while employed.?? We are a drug-free workplace, with no expectations.?? Job Type: Full Time, benefits, 401k Salary: DOE Expected hours:40 hours weekly Monday - Friday?8am-5pm Legacy Engineering, Inc. is an Equal Opportunity Employer (EEOC) and is committed to creating an inclusive environment for all employees. This job description is intended to outline the general responsibilities and qualifications for this role. It is not exhaustive and is subject to change at any time based on the evolving needs of the company.?? Requirements: CERTIFICATIONS LOOK LIKE – This Role Must be fully licensed in both residential and commercial disciplines. Must be a Licensed Building Inspector (Board of Building Code Administrators, Chapter 468, F.S.) and possess all applicable certifications (1 & 2 family, mechanical, electrical, plumbing, fire, etc.).

Job DescriptionPROVIDER AUDIT AND REIMBURSEMENT LEAD AUDITOR (CMS) - REMOTE ARC Group has an immediate opportunity for a Provider Audit and Reimbursement Lead Auditor (CMS)! This position is 100% remote working eastern time zone business hours. This is a direct hire FTE position and a fantastic opportunity to join a well-respected organization offering tremendous career growth potential. 100% REMOTE! Candidates must currently have PERMANENT US work authorization. Job Description: The Provider Audit and Reimbursement Lead utilizes advanced knowledge of Medicare laws, regulations, instructions from the Centers for Medicare and Medicaid Services (CMS), and provider policies to perform desk reviews and audits of the annual Medicare cost reports, as well as interim rate review/reimbursement, and/or settlement acceptance/finalization for all provider types, including complex and organ transplant hospitals, as both a preparer and reviewer of work product based on established performance goals. The position will mentor and train Auditors and In-Charge Auditors and oversee daily workload of unit team. ESSENTIAL DUTIES & RESPONSIBILITIES Lead Accountabilities (60%): • Coordinates with management by overseeing the unit's daily workload. Routinely uses independent judgment and discretion to make decisions for self and less experienced auditors with regard to additional time and procedures; identifies and raises errors to the attention of supervisor and/or provider and identifies and communicates actions to correct same. Prioritizes auditor work and ensures that audit work is completed on time. Recognizes data needs for self and other auditors; develops plan of work for less experienced auditors (10%), • Analyzes working papers and cost reports for errors. (10%), • Reviews workpapers of auditors for correctness, control and adherence to Generally Accepted Accounting Practices (GAAP), Generally Accepted Accounting Standards (GAAS) and Government Auditing Standards (GAS) as required. Examines and reviews workpapers upon completion of the audit to ensure compliance with CMS Uniform Desk Review (UDR), policy, or technical direction and reflects proper reference, clear and concise conclusion of the major audit categories and assembly of working papers into logical sequence. (10%), • Reviews, evaluates and approves the disbursement of tentative cost settlements in compliance with Federal and State Government regulations for each class/type of provider within area of responsibility. (5%), • Develops technical competence and constructive work attitudes in self and less experienced auditors; strives to build an effective team and to develop the growth needs of individual members of his/her team. (10%), • Coordinates the assignments and subsequent development of auditors based on their training needs; explains work to be performed and principle or objective of procedure; provides accurate and constructive coaching, mentoring, and training of team members. Identifies training needs within the team and/or department. (5%), • Manages, implements and coordinates an internal quality control program in conjunction with the Internal Quality Control (IQC) department and provides reasonable assurance that the Provider Audit and Reimbursement Department has established, as well as is following, adequate policies, procedures, and is following applicable auditing standards. (5%), • Facilitates the development of Quality Management System (QMS) policies and procedures. (5%)Auditor Accountabilities (40%), • Performs audit functions including those which are non-routine; keeps track of instructions for many projects simultaneously. Presents and defends adjustments and workpapers to provider with minimal consultation from manager. (10%), • Coordinates large audits and/ or diverse audits independently while seeking help on truly unusual or major items. (10%), • Uses professional communication techniques in own and auditor's work and in conclusions drawn from the work. (5%), • Establishes and maintains constructive provider relations by demonstrating a professional approach, expressing positive corporate image. Advises providers on Medicare policy questions and directs other questions to responsible departments or personnel. (5%), • Conducts entrance and exit conferences and meetings away from office as needed. (5%), • Bachelors' degree or a combination of education and experience in disciplines such as auditing, accounting, analytics, finance or similar experience in lieu of a degree, • A Uniform Desk Review (UDR) and an audit for a large or complex hospital, as the in-charge auditor, • A review of Medicare Bad Debts, inclusive of all relevant sample selection and testing according to CMS standards, • A review of DSH, inclusive of all relevant sample selection and testing according to CMS standards, • A review of IME/GME, inclusive of reviewing rotation schedules, bed count and all relevant testing according to CMS standards, • A review and appropriate approval of an audit's scope, • A supervisory review and approval of all work papers* Sample testing, transferring of testing to the audit adjustment report, and explaining the adjustments to a provider with the achievement of understanding by the provider* Assistance to audit management in the assignment and monitoring of workload, as well as leading junior team members Additionally:, • The auditor must display leadership skills by being integrally involved in junior auditor formal training or assisting on special projects, or have been a Subject Matter Expert (SME)* The auditor must be able to prepare workpapers according to CMS standards, • The auditor must have a good working knowledge of all applicable software applications, • The auditor must be able to serve as an effective mentor for less experienced staff, • The auditor must demonstrate engagement, commitment to departmental success, and professionalism by completing their work within prescribed deadlines, taking ownership of their work and setting an example for more junior auditors and staff by consistently and reliably working the time necessary to properly complete their duties, timely attending meetings, providing adequate notice to management and co-workers when unexpected issues arise, and ensuring work is properly covered in the auditor's absence., • Demonstrated oral and written communications skills, • A review of Nursing & Allied Health Education (NAHE), inclusive of calculating the additional add-on payment and all relevant testing Would you like to know more about our new opportunity? For immediate consideration, please send your resume directly to John Burke or apply online while viewing all of our open positions at . ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed. At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know. Position is offered with no fee to candidate.

Job DescriptionMEDICAL DIRECTOR - REMOTE ARC Group has an immediate opportunity for a Medical Director! This position is 100% remote working eastern time zone business hours. This is a direct hire FTE position and a fantastic opportunity to join a well-respected organization and have a positive impact on the lives of millions of people. At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply. 100% REMOTE! Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering). SUMMARY STATEMENT The Medicare Contractor Medical Director (CMD) provides medical leadership and decision making for an organization that serves as a Medicare Administrative Contractor (MAC). This role serves as a liaison between the Centers for Medicare and Medicaid Services (CMS) and stakeholders. CMDs play a vital role in developing Local Coverage Determinations (LCDs) and ensuring compliance with Medicare policies, reviewing medical claims, and promoting evidence-based healthcare. ESSENTIAL DUTIES & RESPONSIBILITIES Clinical Expertise and Consultation 30% • Provide leadership in clinical program outreach to the practitioner/provider/supplier/beneficiary community., • Provide direction and assistance to clinical staff in conducting provider education, as well as assist in the development of clinical guidelines as needed., • Keep clinical knowledge up to date and abreast of medical practice and technology changes., • Serve as a subject matter expert in medical and clinical areas relevant to the Medicare program., • Provide clinical consultation to internal teams (e.g., medical review staff, appeals teams) and external stakeholders., • Provide the clinical expertise, scientific literature analysis, claims data analytics to effectively focus medical polical policy and reviews on identified problem areas. Collaboration and Leadership 30%, • Collaborate with CMS and other Medicare Contractors (e.g., A/B or DME MACs and others) to develop and update medical policies and articles based on clinical evidence and regulatory requirements., • Work with multidisciplinary teams within the MAC to improve processes and ensure compliance with CMS directives., • Liaise with CMS staff, medical societies, and other stakeholders to align goals and address emerging issues., • Represent the MAC at CMS meetings and industry conferences., • Strengthen the quality improvement procedures with emphasis on decision consistency and clinical education of clinical staff through various mechanisms including but not limited to overseeing Inter-Reviewer Reliability (IRR) reviews. Program Integrity 20%, • Support program integrity initiatives, including identifying trends in inappropriate billing practices or noncompliance., • Ensure the proper application of Medicare regulations, national and local coverage determinations (NCDs and LCDs), and clinical guidelines., • Participate in all phases of LCD development by leading the Local Coverage Determination (LCD) process to include development, revision, retirement, education, and decision making., • Collaborate with investigative teams and law enforcement when required. Medical Review (MR) and Appeals 10%, • Oversee medical review activities to ensure appropriate and consistent decisions on claim determinations including pre- and post-payment determinations., • Provide leadership in developing and implementing MR Quality Assurance Programs., • Provide leadership in effectively focusing MR and developing internal MR guidelines., • Review complex or high-level appeals and provide guidance on the application of Medicare policies., • Provide support to the claim appeal process including assistance in the development of position papers and participation in the administrative process when needed such as Administrative Law Judge (ALJ) hearings. Provider Education and Communication 10%, • Provide leadership in the provider community (including interacting with hospital/specialty associations)., • Educate providers, individually or as a group, regarding identified problems or medical policy., • MD or DO degree from accredited Medical School, • Minimum of three years clinical practice experience as an attending physician, • Extensive knowledge of the Medicare program, particularly the coverage and payment rules, • Work experience in the health insurance industry, a utilization review firm, or another health care claims processing organization in a role that involved developing coverage or medical necessity policies and guidelines., • Knowledge, skill, and experience to evaluate clinical evidence, and to develop evidence-based medical necessity standards within the Medicare fee-for-service benefit structure, • Ability to develop strategies and processes to ensure evidence-based decision-making for policy in the Medicare population, • Basic understanding of medical coding conventions, • Ability to effectively communicate, collaborate with, and provide education on health care policy issues to both internal team members and external entities, • Ability to work collaboratively with internal staff to evaluate aberrancies, determine appropriate billing, coding, pricing, and utilization of services, • Proficiency with effective public speaking and ability educate providers, • Ability to work collaboratively with clinical and non-clinical team members, • Ability and desire to educate team members and external entities (i.e., CMS, providers, other federal agencies, law enforcement, etc.), • Computer literacy, including proficiency using word processing, spreadsheets, presentation, and virtual meeting applications, • Current, active, valid, unrestricted license to practice medicine in at least one state or territory within the United States, never suspended or revoked in any state or territory of the United States, • Eligible for licensure within jurisdiction of enterpriseoperations, • Experienced Physical Medicine and Rehabilitation (PM&R), Oncology, Radiology, Ophthalmology or Infectious Diseases professionals with five years of clinical practice, • MBA, MHA, MS in Management, or formal accredited coursework in medical systems management, • Demonstrated successful working experience in organized medicine group(s) (e.g., AMA, specialty society, state health department) as a committee chairperson or other leadership, • Medical Director experience in Medicare-related or commercial healthcare organization, • Coding and billing experience utilizing HCPCs, CPT, and ICD-10 codes, • Experience using GRADE methodology for literature analysis and performing systematic reviews ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed. At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know. Position is offered with no fee to candidate.

Job DescriptionPROVIDER AUDIT AND REIMBURSEMENT SENIOR AUDITOR (CMS) - REMOTE ARC Group has an immediate opportunity for a Provider Audit and Reimbursement Senior Auditor (CMS)! This position is 100% remote working eastern time zone business hours. This is a direct hire FTE position and a fantastic opportunity to join a well-respected organization offering tremendous career growth potential. 100% REMOTE! Candidates must currently have PERMANENT US work authorization. Job Description: The Provider Audit and Reimbursement Senior Auditor utilizes advanced knowledge of Medicare laws, regulations, instructions from the Centers for Medicare and Medicaid Services (CMS), and provider policies to perform desk reviews and audits of the annual Medicare cost reports, interim rate review/reimbursement, and settlement acceptance/finalization for all provider types including complex and organ transplant hospitals, as both a preparer and reviewer of work product based on established performance goals. The position will mentor and train Auditors and In-Charge Auditors. ESSENTIAL DUTIES & RESPONSIBILITIES Audit Accountabilities (65%) • Analyzes the cost report and computes complex rate reviews on large and medium size facilities for accurate intern payments. (10%), • Analyzes the cost report and completes the calculation of cost-to-charge ratios (CCRs) and provider payment information, ensuring accuracy. (10%), • Analyzes the cost report by comparing the prior year to the current year and completing the desk review, coordinates with Lead on field audits and is in charge of field audits of small, medium and large sized providers and Medicare cost report appeals. (10%), • Performs supervisory reviews of desk reviews performed by other members of the audit staff by providing relevant review points that facilitate the coaching, mentoring, and training of less tenured staff. Ensures that provider desk reviews, cost report appeals and field audits are completed in accordance with CMS regulations and Government Auditing Standards. (10%), • Establishes or maintains constructive provider relations by demonstrating a professional approach, expressing positive corporate image and assisting provider in problem areas. Advises healthcare providers on Medicare policy questions. (10%), • Establishes the timeliness and scheduling of audits and desk reviews to ensure compliance with requirements for CMS metrics and internal production goals. (10%), • Accountable for special projects relating to complex payment methodologies. This involves research, project planning, training of staff and timely implementation of CMS requirements. (5%)Development/Mentoring Accountabilities (30%), • Assigns and develops auditors based on their training needs; explains work to be performed and principle or objective of procedure; provides accurate, constructive feedback; determines future training needs. Identifies training needs within the team and department and provides training to staff on reimbursement principles, the process of completing simple to complicated rate reviews, and for reviewing simple to complex rates at the first review level. (10%), • Serves as a mentor in the department. (10%), • Ensures development of quality product that meets or exceeds CMS expectations. (10%) Other (5%) To demonstrate the necessary experience, the candidate must have performed the following tasks at a sufficiently successful level to show understanding of the work, judgment, and the ability to perform these tasks independent of supervision, which is generally gained through 2 years of Medicare cost report auditing experience: • A Uniform Desk Review (UDR) and an audit for a large or complex hospital, as the in-charge auditor, • A review of Medicare Bad Debts, inclusive of all relevant sample selection and relevant testing according to CMS standards, • A review of DSH, inclusive of all relevant sample selection and relevant testing according to CMS standards* A review of IME/GME, inclusive of reviewing rotation schedules, bed count and all relevant testing according to CMS standards, • A review and appropriate approval of an audit's scope, • A supervisory review of certain provider types (may vary by team), • Sample testing, transferring of testing to the audit adjustment report, and explaining the adjustments to a provider with the achievement of understanding by the provider Additionally:, • The auditor must display leadership skills by being integrally involved in junior auditor formal training or assisting on special projects, or have been a Subject Matter Expert (SME), • The auditor must be able to prepare workpapers according to CMS standards* The auditor must have a good working knowledge of all applicable software applications, • The auditor must be able to serve as an effective mentor for less experienced staff, • The auditor must demonstrate engagement, commitment to departmental success, and professionalism by completing their work within prescribed deadlines, taking ownership of their work and setting an example for more junior auditors and staff by consistently and reliably working the time necessary to properly complete their duties, timely attending meetings, providing adequate notice to management and co-workers when unexpected issues arise, and ensuring work is properly covered in the auditor's absence, • Demonstrated oral and written communications skills, • Demonstrated ability to exercise independent judgement and discretionDemonstrated attention to detail PREFERRED QUALIFICATIONS, • 2 to 3 years of Medicare cost report auditing experience, • A review of Organ Acquisition costs, inclusive of all relevant testing, • MBA, CPA This opportunity is open to remote work in the following approved states: AL, AR, FL, GA, ID, IN, IO, KS, KY, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require further approval. In FL and PA in-office and hybrid work may also be available. Would you like to know more about our new opportunity? For immediate consideration, please send your resume directly to John Burke or apply online while viewing all of our open positions at . ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed. At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know. Position is offered with no fee to candidate.

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Job DescriptionPROVIDER AUDIT AND REIMBURSEMENT MANAGER (CMS) - REMOTE ARC Group has an immediate opportunity for a Provider Audit and Reimbursement Manager (CMS)! Must have experience with Medicare Cost Reports. This position is 100% remote working eastern time zone business hours. This is a direct hire FTE position and a fantastic opportunity to join a well-respected organization offering tremendous career growth potential. 100% REMOTE! Candidates must currently have PERMANENT US work authorization. Job Description: The Provider Audit and Reimbursement Manager is responsible for managing a team of auditors and ensuring the work is performed in compliance with the Medicare laws and regulations, the standards set forth by the Centers for Medicare and Medicaid Services (CMS), the company's and department's quality and production standards, and the company's policies and procedures. The Manager will be responsible for either audit or reimbursement functions and can be responsible for one of four primary roles -- desk review/audit, reopenings/appeals, interim rate review/reimbursement or acceptance/finalization for all provider types as both a preparer and reviewer of work product. The Manager assigns annual workload budget, distributes assignments to the team, ensures timely and accurate completion and review of all work, and makes final reimbursement determinations for all work assigned to the team. ESSENTIAL DUTIES & RESPONSIBILITIES: • Manages team members and workload of the Audit/Reimbursement unit to ensure compliance with the standards set forth by CMS. The standards are in the form of Medicare laws and regulations and budget dollars granted for completion of the workload. (20%), • Manages the daily activities of the Audit/Reimbursement unit, coordinates their interactions with other departments and numerous external entities. Assigned team members can be in more than one office location. (20%), • Coordinates and manages the reimbursement for services, ensures that assigned team members update interim rates and other payment factors, ensures that all changes are entered into the claims processing system, and produces credible output reports that capture all relevant claim payment data required for cost report preparation and settlement. (5%), • Coordinates the testing and validation of the pricing software releases installed in the payment system. (5%), • Manages audits, provides direction to team members via work assignments, coordinates subordinate duties and provides guidance on audit issues. (5%), • Maintains and controls audit and appeal assignments, and also schedules resources to meet performance requirements. (5%), • Ensures that the Provider Audit unit completes its assigned objectives within the limits of established quality, policies, regulations and budgets. Determines the initial plan of audit work to be performed at desk and in the field for all assigned units. (5%), • Reviews workpapers of auditors for correctness, control and adherence to Generally Accepted Accounting Practices (GAAP), Generally Accepted Accounting Standards (GAAS) and Government Auditing Standards (GAS) as required. Examines and reviews workpapers upon completion of the audit to ensure compliance with CMS Uniform Desk Review (UDR), policy, or technical direction and reflects proper reference, clear and concise conclusion of the major audit categories and assembly of working papers into logical sequence. (5%), • Reviews, evaluates and approves the disbursement of tentative cost settlements in compliance with Federal Government regulations for each class/type of provider within area of responsibility. (5%), • Makes accounting decisions relative to audits, conferring, when necessary, with Senior Manager or Director on audit problems and/or interpretations of regulations. (5%), • Reviews completed audit reports and approves them prior to the Senior Manager's or Director's review. (5%), • Attends entrance and exit conferences, lends assistance to auditors as required, and follows up on audit recommendations. Reviews, researches and/or answers inquiries from governmental and other agencies regarding findings made on provider cost reports. (5%), • Researches and reviews all written policies as related to the interpretation and application of governmental regulations on a consistent basis as affecting cost settlements. (5%), • Attends meetings away from office as needed and renders assistance to providers by responding to inquiries. (5%) REQUIRED QUALIFICATIONS, • Bachelors'/Master's degree with a concentration/major in Accounting or Finance. Bachelor's/Master's degree in other fields can qualify if the candidate has 15 or more credit hours in specific Accounting or Finance classes., • 4 years' related work experience in Medicare audit and reimbursement, including 3 years supervisory/project management lead or other leadership experience., • Demonstrated oral and written communications skills, • Demonstrated ability to exercise independent judgement and discretion, • Masters in Business Administration (MBA), • Certified Public Accountant (CPA) This opportunity is open to remote work in the following approved states: AL, AR, FL, GA, ID, IN, IO, KS, KY, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require further approval. In FL and PA in-office and hybrid work may also be available. Would you like to know more about our new opportunity? For immediate consideration, please send your resume directly to John Burke or apply online while viewing all of our open positions at . ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed. At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know. Position is offered with no fee to candidate.

Job DescriptionBenefits: • 401(k), • 401(k) matching, • Health insurance Position Summary: As a Plan Reviewer at Tew & Taylor, you will play a critical role in ensuring compliance with Florida Building Code and local regulations by reviewing construction plans and documents. You will collaborate with clients, contractors, and local authorities to facilitate efficient permitting and construction processes. Key Responsibilities: • Conduct detailed reviews of architectural, structural, mechanical, electrical, and plumbing plans for compliance with Florida Building Code and local ordinances., • Provide clear and concise feedback to clients regarding required corrections or clarifications., • Ensure plan reviews are completed within specified timeframes to meet same-day or next-day service commitments., • Communicate effectively with contractors, design professionals, and permitting officials to address questions or resolve issues., • Stay up-to-date with changes in building codes and regulations and apply them to your reviews., • Maintain accurate records of reviews, correspondence, and project progress., • Collaborate with the inspection team to ensure a seamless process from plan review to project completion.Qualifications:, • A minimum of 5 years of experience in building code plan review or a related field., • Certification as a Plans Examiner or the ability to obtain certification within six months of employment (preferred: ICC or Florida Board of Building Code Administrators)., • Strong knowledge of Florida Building Code, including structural, mechanical, electrical, plumbing, and energy provisions., • Proficiency in reading and interpreting construction documents, including blueprints and specifications., • Excellent communication and interpersonal skills for client-facing interactions., • High attention to detail and the ability to manage multiple projects simultaneously., • Proficiency in Microsoft Office Suite and permitting software (preferred). This is a remote position.

Job DescriptionBenefits: • Dental insurance, • Health insurance, • Paid time off, • Training & development, • Medical, Dental, and Vision Insurance, • Life Insurance, • Disability Insurance, • 403b, • PTO, • Paid Holidays, • Flexible Spending Account Job Summary Mental Health Resource Center is looking for a Utilization Management Reviewer to monitor the utilization of clinical services provided at Mental Health Resource Center (MHRC), using predetermined criteria, review of medical records, and regular participation in treatment team meetings. The crisis stabilization units provide services for adults, adolescents, and children. Most patients are admitted involuntarily to the facility via the Baker Act, the mental health act of Florida. The normal length of stay on the unit for patients is typically 3-5 days. Due to the types of services provided, crisis stabilization units are a fast paced working environment and present employees with challenging and rewarding opportunities. Employees work together and support one another in a friendly, team oriented atmosphere. Responsibilities • Reviews medical records and attends treatment team meetings to review utilization of resources and the level of care provided. Ensures utilization and level of care are appropriate based on the diagnosis, needs, age and culture of the individual., • Carries out appropriate telephone and written communication with insurers and third party payers regarding referrals, admissions, medication changes, discharges and changes in level of care., • Coordinates on-site review of medical records with reviewers from third party payers., • Documents, updates, and manages patient and provider information using internal electronic records system., • Coordinates psychiatric consultations between internal and external providers., • Investigates complaints, grievances, and medication variances. Reports findings to Utilization Management Manager and completes necessary follow up., • Registered Nurse: Associate Degree in Nursing required., • One year experience in psychiatric nursing required. Valid Florida RN License required.OR, • Licensed Practical Nurse: Graduation from an accredited school of Practical Nursing required., • Two years experience in psychiatric nursing required. Valid Florida LPN License required.OR, • Masters degree in Psychology or Human Services related field required., • Three years experience in the mental health field required. UM experience preferred.Requires telephone and person-to-person interactions with individuals with mental illness on locked inpatient units. Excellent communication skills are essential and this individual must be able to interact appropriately with internal and external customers, including families, caregivers, community service providers, supervisory staff and other department professionals. Each employee contributes to the completeness and confidentiality of clinical records by ensuring documentation, paperwork and system entries meet internal and external guidelines for content, accuracy and timeliness. Position Details This is a full time position, Monday through Friday, 7:00am to 3:30pm Renaissance Behavioral Health Systems and Mental Health Resource Center are Equal Opportunity Employers.

We're currently looking for individuals across the country to take part in remote paid research, including remote focus groups, product trials, and consumer studies.Earn up to $750 a week in your free time by providing feedback on everyday products and services.If you're comfortable sharing your opi

We're currently looking for individuals across the country to take part in remote paid market research, including online focus groups, product trials, and consumer studies.Earn up to $750 a week in your free time by providing feedback on everyday products and services.If you're comfortable sharing y

Customer Service / Remote] - Anywhere in U.Up to $23 per hour / Medical, dental & vision / 401k / PTO - As a Call Center Rep at SCA Health, you will: Take inbound calls from patients and make outbound calls to patients; Provide one call resolution to patient inquires whenever possible and perform ti

Call Center / Remote] - Anywhere in U.Competitive pay / Medical, dental & vision / 401k / PTO - As a Customer Service Rep at Planet Home Lending, you will: Respond to borrower inbound calls concerning their account, ensuring high quality service and adhering to productivity and regulatory requiremen

Seeking participants for Focus Group and market research studies.Work part-time from home and earn up to $750 per week.Register to see if you are eligible.Call Center Representative Agent experience not required.Remote Work From Home Call Center Representative Agent - Part Time Market Research Panel

Seeking participants for Focus Group and market research studies.Work part-time from home and earn up to $750 per week.Register to see if you are eligible.Customer service representative agent experience not required.Remote Work From Home Customer Service Representative Agent - Part Time Market Rese

Seeking participants for Focus Group and market research studies.Work part-time from home and earn up to $750 per week.Register to see if you are eligible.Administrative Assistant admin experience not required.Remote Work From Home Administrative Assistant Admin - Part Time Market Research Panelists

Seeking participants for Focus Group and market research studies.Work part-time from home and earn up to $750 per week.Register to see if you are eligible.Data Entry experience not required.Remote Work From Home Data Entry Clerk - Part Time Market Research Panelists Our company is seeking individual

As a FT Call Center/Customer Service Rep [Work From Home], you will: Handle incoming calls and inquiries from customers in a professional and courteous manner; Provide accurate and efficient assistance with customer inquiries, complaints, and requests; Maintain a high level of product knowledge to e

Customer Service / Remote] - Anywhere in U.Medical, dental & vision / 401k / PTO / Equipment provided - As a Call Center Associate at Vector Security, you will: Receive inbound communications from customers via multiple channels including phone, chat, email and text and provide positive customer exp

CSR / Remote] - Work from Anywhere in U.Company Match / Paid Vacation / Health Insurance (Available Immediately) - As a Call Center Representative at 160 Driving Academy, you will: Answer incoming calls and respond to customer inquiries manage a high volume of customer calls with professionalism and

Call Center / Remote] - Anywhere in U.Competitive pay / Medical, dental & vision / 401k / PTO - As a Customer Service Rep at Knipper Health, you will: Promote meaningful relationships and brand loyalty through engaged and informed conversation with customers (health-care providers, office staff, pat

Customer Service / Remote] - Anywhere in U.Competitive Pay + Bonus Eligibility / Medical-Dental-Vision-HSA / 401(k) matching / PTO - As a Call Center Representative, you will: Provide excellent customer service by answering inbound calls and responding to inquiries in a timely and professional manne