- Novo Nordisk Inc. (San Mateo, CA)
- …level impact Demonstrates understanding of the local payer market including Medicare , Commercial and Medicaid benefit designs, Payer Coverage, Prescription Coverage ... of territory customer groups and affiliations such as IPAs, Medical Groups, Health Systems , and Local Clinics and uses this to identify business opportunities and… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- …field and home office stakeholders. External relationships include Managed Care & Medicare customers, Market Access and System Vendors. Essential Functions ... treasury reporting, monthly and periodic reconciliations to other reporting systems ) Identifies and analyzes performance trends and provides recommendations and… more
- Daiichi Sankyo, Inc. (Seattle, WA)
- …landscape, the appropriate utilization of NCCN/ASCO guidelines, private payer, GPOs, Medicare and Medicaid structure, Specialty Pharmacy systems and ... purpose of this role is to serve as a field-based, product access specialist that provides appropriate reimbursement support to HCPs to help facilitate patient… more
- Medical Mutual of Ohio (OH)
- …substance abuse and nicotine testing._ **Title:** _Clinical Services Support Specialist ( Medicare UM)_ **Location:** _Ohio_ **Requisition ID:** _2400556_ ... insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Under general… more
- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment, you will be an expert in risk adjustment coding and ... A Certified Professional Coder (CPC) certification or Certified Coding Specialist (CCS) certification, required + A Certified Risk Adjustment...of ICD-10, CPT and CPT (II), and HCPCS coding systems required + Knowledge of Medicare Advantage… more
- CVS Health (Monroeville, PA)
- …also provides free parking. **What you will do** + Timely response to Medicare audits and appeals + Research and gather the appropriate documentation to form ... all levels of appeals for Medicare + Third party follow-up associated with the dispensing...balances + Maintain patient demographic information and data collection systems Research and respond by telephone, via the internet… more
- PruittHealth (Norcross, GA)
- …In-depth knowledge of various billing documentation requirements, the patient accounting system , and various data entry codes to ensure proper service documentation ... functions in non-acute settings * Knowledge of Patient Management information system applications, preferably MatrixCare, as well as spreadsheet, word processing,… more
- Sea Mar Community Health Centers (Mount Vernon, WA)
- …by contracted entities such as Accountable Communities of Health and Medicaid/ Medicare organizations. + The TOC Integration Specialist must maintain the ... a mandatory COVID-19 and flu vaccine organization Transition of Care Integration Specialist - Posting #27118 Hourly Rate: $26.52 Position Summary: Sea Mar Community… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …irregularities; determining continuing needs for Tele-Sale Agents, Benefit Navigators and Medicare Support Specialist . + Ensure all Tele-sale Agents, Benefit ... Navigators, and Medicare Support Specialists are conducting activities that are in...the Training Director + Maintain hard copy/ electronic filing system + Maintain office supply inventories + Record, compile,… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …consider collective experience, training and education. . 5 years as an Appeals Specialist or equivalent experience in Medicare health insurance claims, customer ... related to member and provider appeal issues, including identifying needed system changes and contacting other areas to implement those changes. **Responsibilities**… more
- BeneLynk (San Antonio, TX)
- …to Medicare Advantage beneficiaries enrolled in a BeneLynk contracted Medicare Advantage plan. The Member Engagement Specialist makes outbound telephone ... the advocacy that changes lives and improves outcomes. Everything we do, from the systems we build, to our government relations, to our outreach operations, is in… more
- Point32Health (Canton, MA)
- …(PBPs) are reviewed and ready for bid filing in CMS' Health Plan Management System (HPMS). The Senior Manager will also be responsible for either directly populating ... of the broader Product team who assist with product / system configuration, regulatory applications/filings, and day-to-day benefit adjudication matters. Overall,… more
- Medical Mutual of Ohio (OH)
- … Advantage, Medicare Supplement, and individual plans. **Responsibilities** **Business Systems Specialist I** Works with management, external vendors, and ... without resulting in negative impacts to functionality. . Analyzes systems issues to determine system or procedural...junior staff. . Performs other duties as assigned. **Business Systems Specialist II** Works with management, external… more
- Mount Sinai Health System (New York, NY)
- …:** Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight ... Description** A member of MSHS regulatory team, the Accreditation Specialist is a key leader and participant in the... is a key leader and participant in the systems continuous accreditation and regulatory readiness program. Responsible for… more
- UCLA Health (Los Angeles, CA)
- Description Take on a key role within an award-winning health system . Help improve patient experiences and operational efficiency as part of a world-class healthcare ... can do all this and more at UCLA Health. As member of the Medicare Advantage Risk Adjustment leadership team, the Assistant Director of Risk Adjustment is… more
- Ventura County (Ventura, CA)
- …of payment systems , including CPT, ICD-10, and HCPCS codes for Medicare and Medi-Cal payment processing. They are adept with the Medi-Cal Provider Manual ... for Medi-Cal and/or Medicare and prepares reports; + Serves as lead biller/ specialist to the department; and + Performs other related duties as required. Medical… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Under direct supervision, ... and credentialing into the various modules of the Provider Data Management System . Supports compliance with standards set by individual states, federal and… more
- Henry Ford Health System (Troy, MI)
- …SUMMARY: Reporting to the Manager, Revenue Integrity, the Revenue Integrity Senior Specialist has an important role in a high-profile group tasked with improving ... more senior Revenue Integrity leaders, the Revenue Integrity (RI) Senior Specialist is responsible for the facilitation of multiple Revenue Integrity initiatives… more
- Ventura County (Ventura, CA)
- …codes, International Classification for Diseases (ICD)-10 codes, Health Care Procedure Coding System (HCPCS) codes for payment processing of Medicare and/or ... Medical Billing Specialist I/II Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4658466) Apply Medical Billing Specialist I/II Salary… more
- Centers for Medicare & Medicaid Services (Woodlawn, MD)
- …for developing, analyzing, implementing, and modifying operating policy/procedures and systems business requirements relating to collection of Medicare ... for developing, analyzing, implementing, and modifying operating policy/procedures and systems business requirements relating to collection of Medicare … more
