- Teva Pharmaceuticals (Parsippany, NJ)
- Medicaid Claims Analyst Date: Oct 21, 2024 Location: Parsippany, United States, New Jersey, 07054 Company: Teva Pharmaceuticals Job Id: 57268 **Who we are** Teva ... us on our journey of growth! **The opportunity** The Medicaid Claims Analyst is responsible for ... analyzes and documentation on assigned states/programs. Communicate to manager for key findings and changes to state programs.… more
- Guidehouse (Lewisville, TX)
- …from home._** **_Questions regarding this position, you may contact Chris Rivera ( Manager , Talent Acquisition) at ###_** **Essential Job Functions** + Account Review ... + Appeals & Denials + Medicare/ Medicaid + Insurance Follow-up + Customer Service + Billing + UB-04 & CMS 1500 + Complete all business-related requests and… more
- CVS Health (Columbus, OH)
- …affordable. **Position Summary** Reviews, analyzes, negotiates, and executes complex Medicaid contracts with health systems, physician groups, and behavioral health ... liaison to internal colleagues to interpret contracts, drive cost savings, resolve claims and other service issues. **Required Qualifications** + 7-10 years work… more
- New York State Civil Service (New York, NY)
- …for defrauding New York state out of more than $4 Million in false Medicaid claims .Duties: * Assisting with screening and evaluating complaints of abuse and ... Attorney General, Office of the Title Legal Nurse: Medical Analyst Support Medicaid Fraud Cases (6345) Occupational Category Legal Salary Grade NS Bargaining Unit… more
- Humana (Indianapolis, IN)
- …The Provider Education & Outreach Representatives serve as the primary relationship manager with providers to ensure positive provider experience with Humana Healthy ... policies and procedures, explain Humana systems, etc. + Serves as primary relationship manager with LTSS and HCBS providers and/or PH and BH providers to ensure… more
- UCLA Health (Los Angeles, CA)
- Description We are seeking a detailed-oriented and experienced Claims Manager to join our Claims leadership team. In this key role, you will oversee a ... dedicated team of claims examiners, auditors, and support staff, and monitor the...American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) coding guidelines such as the National… more
- Apex Health Solutions (Houston, TX)
- Summary: Position is responsible for oversight of claims adjudication and regulatory reporting functions including all associated processes, reporting of key ... also responsible for the timely processing and accuracy of claims and day to day interactions with any vendor...of health insurance industry with all product lines (Medicare, Medicaid , Commercial, ASO, DSNP, etc ) Extensive knowledge of… more
- Elevance Health (Tampa, FL)
- RN Utilization Management Nurse Sr. ( Medicaid -InPatient) JR130851 **Location:** Must be within 50 miles / 1 hour commute of Tampa or Miami, FL offices. This is ... Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied. Primary duties may… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Accounting Clerk (Commercial Claims Follow-up) Full-Time M-F 9AM to 5PM East 42nd Street** Under the supervision of the Patient Financial ... Supervisor/ Manager , performs a variety of patient accounting functions, including...including but not limited to financial verification, preparation of Medicaid applications, billing, processing accounts, payment and/or charge posting,… more
- Fallon Health (Worcester, MA)
- …+ Seeks intermittent assistance from Team Subject Matter Experts (SMEs), the Trainer and Claims Manager to ensure accuracy of adjudicating claims and to ... **Overview** **The Claims Examiner position is a hybrid role working...the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the… more
- Prime Therapeutics (Columbus, OH)
- …fuels our passion and drives every decision we make. **Job Posting Title** Claims Technical Analyst, Sr. **Job Description** The Senior Claims Technical Analyst ... is responsible for serving as the claims analysis resource for assigned operations teams. This role...with Medicare Part D and Centers for Medicare and Medicaid Services rules and regulations **Preferred Qualifications** + Training… more
- Marshfield Clinic (Marshfield, WI)
- …to support the most exciting missions in the world!** **Job Title:** Claims Examiner I (Remote/Hybrid Option) **Cost Center:** 682891379 SHP- Claims **Scheduled ... am - 5:00 pm (United States of America) **Job Description:** **JOB SUMMARY** The Claims Examiner I is responsible for examining claims for accurate processing… more
- AristaCare (Cranford, NJ)
- …families of the changes + Submit Billing Assistance form to Provider Relations for Medicaid claims + Submit cases to attorney if potential problem. + Work ... few years of experience as a SNF Business Office Manager with thorough knowledge of the Medicaid ...with County Social Security Office supervisor to ensure all claims are processed correctly and rapidly. + Work with… more
- Fallon Health (Worcester, MA)
- …be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the Elderly)- in ... Under the general direction of the Senior Internal Audit Manager , theAnalyze and interpret patient medical records pertaining to...to FWA investigations Compare to information submitted on the claims in order to determine amount and nature of… more
- Intermountain Health (Murray, UT)
- **Job Description:** The Pharmacy Services Manager provides leadership and direction to SelectHealth Pharmacy Services and SelectHealth Prescriptions. This position ... contributes to the strategic and clinical direction of the department. The Manager identifies and promotes the changes needed to provide cost-effective quality… more
- Intermountain Health (Murray, UT)
- **Job Description:** The Pharmacy Services Manager provides leadership and direction to SelectHealth Pharmacy Services and SelectHealth Prescriptions. This position ... contributes to the strategic and clinical direction of the department. The Manager identifies and promotes the changes needed to provide cost-effective quality… more
- University of Rochester (Rochester, NY)
- …resolution and adjudication, including refund of credits + Review and advise supervisor or manager on trends of incorrectly paid claims from specific payers + ... and/or trends that require management intervention; share with Supervisor and or Manager . Assist Supervisor with Medicare and Medicaid credit balance audits,… more
- Robert Half Finance & Accounting (Windsor, CT)
- …critical financial operations within the facility. Job Overview: As the Business Office Manager , you will be responsible for managing Medicaid and Medicare ... Description Business Office Manager - Long Term Care/Skilled Nursing Location: Windsor,...general ledger. + Ensure accurate and timely submission of Medicaid and Medicare claims , and manage follow-up… more
- CVS Health (Austin, TX)
- …health care more personal, convenient and affordable. **Position Summary** As a Benefit Testing Manager , you will be part of Client Benefit Services QA team that is ... You will be responsible for performing analytical skill to review different Medicaid state compliance Benefit programs and translate those into business rule and… more
- University of Rochester (Rochester, NY)
- …resolution and adjudication, including refund of credits + Review and advise supervisor or manager on trends of incorrectly paid claims from specific payers + ... as to the processes necessary to collect denied insurance claims and resolve billing issues. Must track payer/billing issues...tasks, following standard procedures, and as directed by the Manager , Billing or Manager . Independent judgement is… more