- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Group Medicare Proposal Development/Contract Review Professional 2 reviews solicitations and prepares ... simple requests for proposals (RFPs)/request for renewals (RFRs). The Group Medicare Proposal Development/Contract Review Professional 2 is primarily responsible… more
- Molina Healthcare (Columbus, OH)
- …the product choices available to them, the enrollment process (eligibility requirements, Medicare review /approval of their enrollment application, timing of ID ... for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare -Medicaid recipients within approved… more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... us on Facebook, Twitter and LinkedIn. **Responsibilities** The Chart Review Specialist primary responsibility is to review ,...Chart Review Specialist primary responsibility is to review , analyze and report on FCHP patient charts for… more
- Actalent (Mcallen, TX)
- …record, quality improvement, medical, medical terminology, audit, health care, data, medicare , chart review , ncqa, insurance, data entry, microsoft excel, ... calls, support Top Skills Details: HEDIS,medical record,quality improvement,medical,medical terminology,audit,health care,data, medicare ,chart review ,ncqa Additional Skills & Qualifications: 2… more
- Guidehouse (Lewisville, TX)
- …Chris Rivera (Manager, Talent Acquisition) at ###_** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare /Medicaid + Insurance Follow-up + ... appeals & denials. **What Would Be Nice To Have** **:** + Has active Medicare appeal process experience + PC skills in a Windows environment are required. Knowledge… more
- AdventHealth (Altamonte Springs, FL)
- …insured and, if so, gathers details (eg, insurer name, plan subscriber) . Performs Medicare compliance review on all applicable Medicare accounts in order ... patients . Verifies medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility… more
- AdventHealth (Manchester, KY)
- …insured and, if so, gathers details (eg, insurer name, plan subscriber) * Performs Medicare compliance review on all applicable Medicare accounts in order ... patients * Verifies medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility… more
- AdventHealth (Hinsdale, IL)
- …insured and, if so, gathers details (eg, insurer name, plan subscriber) + Performs Medicare compliance review on all applicable Medicare accounts in order ... patients + Verifies medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility… more
- Humana (Columbus, OH)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to… more
- Humana (Columbus, OH)
- …group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and/or Medicaid requirements, and will understand how… more
- Insight Global (Melville, NY)
- …training sessions and meetings Call prospective as well as existing clients to review Medicare health insurance plans Represent leading insurance carriers with ... Job Description Job Summary As an inside Medicare sales representative, you will be responsible for selling Medicare products and programs to potential and… more
- Health First (Cocoa Beach, FL)
- …and secure the required forms to meet compliance with regulatory policies. 3. Perform Medicare compliance review on all applicable Medicare accounts in order ... to determine coverage. Identify patients who may need Medicare Advance Beneficiary Notices of Noncoverage (ABNs). Issues ABN forms as needed. 4. Complete Medicare… more
- CareFirst (Baltimore, MD)
- …medical pre-authorization review , Commercial inpatient and outpatient behavioral health review , Medicare intake and medical pre-authorization review , ... Medicaid / Medicare intake, and Medicaid / Medicare medical pre-authorization review . More detail can be shared during the interview process. Plans,… more
- University of Rochester (Rochester, NY)
- …audits, and third-party payor audits.** + Coordinate responses and resolution to Medicaid and Medicare credit balances + Review all accounts on the Medicaid and ... Microsoft Word, Excel, Access, Email, Emdeon (Fidelis Medicaid Managed Care and Medicare Part B) clearinghouse software, third party claims systems (ePaces, Omnipro)… more
- Healthfirst (NY)
- …or any related degree + Experience in the actuarial field related to Medicare (bid development/ review , analysis, reporting, risk scores) + Ability to collect, ... **Duties and Responsibilities:** + Monitor experience under Healthfirst's Medicare line of business. + Provide support for... line of business. + Provide support for annual Medicare bids for all Healthfirst's Medicare products.… more
- R1 RCM (Boise, ID)
- …a Medical Billing Associate:** + Work through queues to resolve unpaid and underpaid Medicare claims + Review Return to Provider claims, correct or reroute ... to focus on patient care. Every day you will review , correct, and reroute open claims and update claims...in this role, you must have prior acute care Medicare billing experience. **Here's what you will experience working… more
- Nuvance Health (Poughkeepsie, NY)
- …* * Maintain A/R and follow up of all accounts with the exception of Medicare .* * Review of cash deposits for proper payments. * Claim research for ... Abilities Requirements:* * Knowledge of insurance guidelines including HMO/PPO, [ Medicare ](https://www.verywellhealth.com/ medicare -4014366), [Medicaid](https://www.verywellhealth.com/medicaid-4014367), and other payer requirements and… more
- University of Rochester (Rochester, NY)
- …audits, and third-party payer audits. + Coordinate responses and resolution to Medicaid and Medicare credit balances + Review all accounts on the Medicaid and ... final resolution and adjudication, including refund of credits + Review and advise supervisor or manager on trends of...of reports: + 2 nd insurance level report + Medicare and Medicaid credit balance report + Over $10,000… more
- Masonicare (Wallingford, CT)
- …family and interdisciplinary care team. + Organize and participate in the daily Medicare meeting, utilization review and monthly end of close meetings. + ... relates to facility care practices + Manages the patient's Medicare benefit by communication of skilled needs to the...Assists with Medicare denial claims/reviews when need is identified by billing… more
- State of Connecticut, Department of Administrative Services (Middletown, CT)
- …in state health care facilities for purposes of maximizing reimbursement revenue via Medicare Part B programs; + May review medical records and compile ... Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment #...care providers; + May supervise and participate in hospital Medicare and Medicaid reimbursement programs including preparation of appeals… more