- Sanford Health (Grand Forks, ND)
- …**Weekly Hours:** 40.00 **Salary Range:** $27.50 - $44.00 **Job Summary** The Senior Reimbursement Analyst provides critical analytical and reimbursement ... and implementing new payment methodologies in order to establish optimal reimbursement and payment levels. Recommends policies and procedures for reimbursement… more
- CommonSpirit Health (Englewood, CO)
- …happen both inside our hospitals and out in the community. **Responsibilities** The ** Senior Reimbursement Analyst i** s responsible for providing cost report ... preparation, cost report appeals , audit preparation and other duties related...the improvement of internal business processes and meeting future reimbursement service needs. The Senior Reimbursement… more
- Walmart (Bentonville, AR)
- …the development and then drive strategies to address crafting and executing audit plans, negotiation strategies, managing appeals , and at times supporting ... Experts (SMEs) in the implementation and execution of foreign audit plans, along with alternative dispute resolution strategies +...company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement , and more. You will also… more
- Medical Mutual of Ohio (OH)
- …outbound calls to members, providers, and pharmacies to initiate coverage determinations/ appeals , prescription refills, and switch members to lower cost therapeutic ... or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals , Grievances, and Medicare marketing material requirements. . Assists in… more
- Walmart (Bentonville, AR)
- …resolve non-U.S. tax controversies, including foreign country tax audits, tax appeals , and tax litigation. + Provide global insight, expertise, and oversee ... Experts (SMEs) in the implementation and execution of foreign audit plans and alternative dispute resolution strategies + Support...company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement , and more. You will also… more
- Hackensack Meridian Health (Hackensack, NJ)
- …denials by: I. Peer-to Peer (P2P) Concurrent appeals ii. Written Concurrent appeals iii. Recovery Audit Contractors & levels of appeal iv. Root cause ... **Overview** The Senior Utilization Review Specialist collaborates with the healthcare...include but are not limited to utilization review, hospital reimbursement , clinical compliance, case management, and transitions of care,… more
- Hackensack Meridian Health (Hackensack, NJ)
- …by:** **I. Peer-to Peer (P2P) Concurrent appeals ** **ii. Written Concurrent appeals ** **iii. Recovery Audit Contractors & levels of appeal** **iv. Root ... These include but are not limited to utilization review,** **hospital reimbursement , clinical compliance, case management, and transitions of care, as** **outlined… more
- Stanford Health Care (Palo Alto, CA)
- …and cash posting of all hospital charges from all payors. The Senior Manager assists the Director in establishing the organizational priorities and operational ... strategies to drive optimal performance of the Hospital Revenue Cycle. The PFS Senior Manager acts as a liaison between PFS operations and other departments in the… more
- Vanderbilt University Medical Center (Nashville, TN)
- …audits and appeals related to disputed issues. Prepares slides of audit results for inclusion in presentations to unit leaders and executive steering committees. ... Prepares data for inclusion in presentations on strategic requirements to senior leadership related to implementations of systematic and procedural changes to… more
- Ascension Health (Glendale, WI)
- **Details** + **Department: Recovery Audit Compliance** + **Schedule: Full Time, Days, (M-F 8a-5p - some flexibility)** + **Hospital: AW Glendale Corporate Office** ... disability Employee assistance programs (EAP) Parental leave & adoption assistance Tuition reimbursement Ways to give back to your community _*Please note, benefits… more
- Zelis (NJ)
- …overall claims progression + Complete claims processing after the Clinical Bill Review and Audit analysis is completed. + Assist in appeals process as necessary ... to be applied to Zelis coding and clinical reviews + Translate client reimbursement policies into Zelis coding and clinical concepts + Provide direction to internal… more
- LA Care Health Plan (Los Angeles, CA)
- …setting. Experience in health care auditing and monitoring (preferably in Appeals , Grievances, Quality Improvement, Utilization Management (UM) and so forth) and ... developing audit tools. Demonstrated experience developing and delivering training programs...to state/federal sanctions and fines- communicate required action to senior management/Board of Governor (BoG), Plan Partner staff. 2.… more
- UPMC (Pittsburgh, PA)
- …hours. This position is eligible to work from home after training. The Senior Authorization Specialist is to perform authorization activities for a broader scope of ... which all work is to conform. The expertise of the Authorization Specialist Senior shall include an in-depth working knowledge in the area of authorization related… more
- Banner Health (AZ)
- …payors or reviewers to resolve denial management issues, reconsiderations and appeals . 3. Tracks, monitors and documents denial causes and resolutions with ... Patient/family, medical staff, case managers, nursing, social workers, patient services/placement/finances/ audit , emergency department, clinic and all other departments and… more
- Tufts Medicine (Boston, MA)
- …on performing the following Patient Financial Services duties: Facilitates the reimbursement for clinical services provided to patients. Submits claims to health ... insurers, follows up with health insurers about submitted claims, and performs appeals for non-clinical denials, etc. An organizational related support or service… more
- University of Connecticut Foundation Inc (Storrs, CT)
- …and overall content for campaign communications including event talking points, appeals and invitations, proposals, web content, campaign collateral, and stewardship ... to creative content development. + Effectively collaborate and brainstorm with Foundation senior leadership team, development staff and other key matrix partners to… more