- Stanford Health Care (Palo Alto, CA)
- …and regulatory reports to government agencies, including but not limited to: - Medicare and Medi-Cal cost reports -Financial disclosures to the Department of Health ... timely and accurate filing of annual government cost reports, including Medicare , Medi-Cal, and HCAI submissions. + Maintain comprehensive knowledge of federal… more
- Sun Pharmaceuticals, Inc (Washington, DC)
- …in access and reimbursement issues encompassing coverage, prior authorizations, appeals , exceptions, denials, coding and payer payment guidelines, payer policies, ... care to support patient options. + Possess expertise in Medicare policies and the variations within all parts of... policies and the variations within all parts of Medicare + Ensure processes are in place to drive… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …and support physician review to ensure timeliness, accuracy and reliability of UM and Appeals reviews\. + Lead and serve on various committees in order to accomplish ... + Ability to interpret and explain complex government policies + Knowledge of Medicare programs Employees who are required to operate either a BCBST\-owned vehicle… more
- Commonwealth Care Alliance (Boston, MA)
- …Referral and authorization; Regulatory compliance; Billing and payments; Complaints and appeals ; Policies and procedures. + Identify opportunities for training and ... + Experience in health plan provider relations. **Experience (Desired)** + Medicare /Medicaid experience preferred. + Experience with CPT coding and authorization… more
- CVS Health (Hartford, CT)
- …based anywhere in the US.** **Responsibilities of this Medical Director role are related to Medicare Appeals :** * Direct daily work on part C appeals (both ... policy for the enterprise * Provide ongoing education regarding Medicare policy and appeals to the appeal nurses and territory Utilization Management Staff *… more
- Elevance Health (FL)
- ** Appeals Medical Director - Medicare ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... required by law. Alternate locations may be considered. The ** Appeals Medical Director** is responsible for the appeal reviews...the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more
- CVS Health (Columbus, OH)
- …role, you will be responsible for processing the medical necessity of Medicare appeals for participating providers. **Key Responsibilities** + Requesting ... And we do it all with heart, each and every day. **Position Summary** CVS Aetna is seeking a dedicated ** Appeals Nurse Consultant** to join our remote team. In this… more
- Humana (Lincoln, NE)
- …us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments ... data requires a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical...includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above… more
- OhioHealth (Columbus, OH)
- …Manager with updates. CGS audits and auditors Working with our legal vendor for Medicare Appeals . Working with OHA and CBSA facilities on wage index ... Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This position… more
- Molina Healthcare (Omaha, NE)
- …benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory ... with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Facilitates comprehensive… more
- NTT America, Inc. (Plano, TX)
- …Senior Manager to join our team. NTT DATA is seeking to hire a ** Medicare Appeals Clinical Leader** to lead service delivery engagements and improve end-to-end ... delivery of Medicare Appeals . Desire experience specifically for processes for clinical appeals coordinators but this role will be a leader in the end-to-end… more
- Guidehouse (El Segundo, CA)
- …and three days from home._** **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 correspondence from patients and insurance companies. + Responsible for working on 40-70 Accounts Per Day + Complete all assigned projects in a timely manner. + Assist client and… more
- US Tech Solutions (RI)
- …volume where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government ... clients or lines of business and in accordance with Medicare Part D CMS Regulations. + Must apply information...coverage requests. + Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. +… more
- US Tech Solutions (May, OK)
- …volume where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government ... requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided through multiple channels… more
- US Tech Solutions (May, OK)
- …authorizations. **Responsibilities:** + Ensure accuracy of case setup and clinical review of Medicare appeals cases. + Review internal notes or fax requests ... for clinical information to decision cases + Utilize work instructions and Medicare guidelines for accurate case processing. + Comply with CMS mandated timelines… more
- NHS Management, LLC (Tuscaloosa, AL)
- …Assists the Director of Medicare and Rehabilitation in gathering information for Medicare and Medicaid appeals and denials as requested. + During facility ... well as Company policy and procedure Directs the MDS assessment and Medicare related activities of the assigned facilities, ensuring accurate and timely assessments… more
- The Wesley Community (Saratoga Springs, NY)
- …and x ray vendors receive required resident information for services. + HMO and Medicare appeals management. + For medical records requests follow medical record ... release policy. Gather and organize mailings, track dates and maintain a log of requests. + Ensures unit secretaries manage resident appointments to include all required steps in process following the "appointment procedure" to include transportation. +… more
- CVS Health (Sacramento, CA)
- …Summary** Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple issues and, may ... responses from multiple business units. Ensure timely, customer focused response to appeals . Identify trends and emerging issues and report and recommend solutions.… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is...LA Care's Policies & Procedures that meet Centers for Medicare and Medicaid Services (CMS), the California Department of… more
- LA Care Health Plan (Los Angeles, CA)
- …(20%) Supports the identification, investigation and resolve administrative complaints, simple appeals while adhering to Center for Medicare and Medicaid ... Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category:...1 year of experience in Managed Care working with Medicare , Medi-Cal and other State Sponsored programs. Experience working… more
