- New York State Civil Service (Albany, NY)
- …HELP Yes Agency Medicaid Inspector General, NYS Office of the Title Medicaid Integrity Specialist 1/Trainee 1/Trainee 2 NY HELPS Occupational Category Other ... Medicaid Managed Care/Family Health Plus/HIV Special Needs Plan Contract and other federal and state laws and regulations...care reviews.* Apply Medicaid policy, regulations and Medicaid managed care contracts to reviews.* Prepare… more
- LA Care Health Plan (Los Angeles, CA)
- …in the Product Development Lifecycle and or initiatives through the management of contracts and regulatory filings. Collaborate with leadership to develop the ... Product Solutions Specialist II Job Category: Sales & Marketing Department:...initiatives. This position is focused on applying technical healthcare contract expertise in performing in the development and management… more
- Priority Health Care (Marrero, LA)
- JOB SUMMARY: The Revenue Cycle Specialist II must adhere to the Code of Ethical Conduct and foster positive relationships within the company, across departments, and ... letters, engaging in extensive telephone contact with insurance companies, using contract summaries to verify balances due on disputed claims, and coordinating… more
- Humera (Minnetonka, MN)
- …proofreading, and editing skills with a side of health insurance (Medicare and/or Medicaid preferred). The Document Production Specialist II is responsible for ... Document Production Specialist II (818195) | Minnetonka, MN Document Production...formatting, editing, proofreading and coordinating the releasing of the contracts . + Develop, produce and maintain contract … more
- CareFirst (Baltimore, MD)
- …Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist , will analyze clinical information, contracts , mandates, medical ... FUNCTIONS:** + Determines medical necessity and appropriateness by referencing regulatory mandates, contracts , benefit information, Milliman Care Guidelines,… more
- Josselyn (Northbrook, IL)
- …successfully completing the initial and subsequent credential packages as required by regulatory agencies, commercial payors, and Medicaid and Medicare. This ... - Friday, 8:30 AM - 4:30 PM Job Summary The Credentialing and Billing Specialist is responsible for maintaining active status for all clinicians and physicians by… more
- CenterLight Health System (Flushing, NY)
- JOB PURPOSE: The Claims Specialist will support department operations related to provider communication, pended claim review, reporting, auditing, and oversight ... State, Federal, and contractual guidelines. JOB RESPONSIBILITIES: + The Claims Specialist will be responsible for reviewing claims processed by the outside… more
- Amergis (Knoxville, TN)
- …federal regulatory referrals (eg, the Joint Commission) for certified Medicare/ Medicaid entities with immediate jeopardy infection control tags. + Responds to ... Amergis Healthcare Staffing is Hiring an Infection Prevention Specialist in Knoxville. Details below: + Infection Prevention...pm M-F + $45 an hour + 12 month contract + Benefits offered, 401k, and weekly pay +… more
- University of Utah Health (Salt Lake City, UT)
- …obtained before expiration. + Ensures compliance with UUMG delegated credentialing contracts in accordance with regulatory requirements and accreditation ... Utah Health Care in accordance with the Medical Staff Bylaws, applicable regulatory requirements and accreditation standards. This position is not responsible for… more
- Molina Healthcare (GA)
- …with regulatory requirements. + Research claims processing guidelines, provider contracts , fee schedules and system configurations to determine root cause of ... and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution… more
- Rush University Medical Center (Chicago, IL)
- …Schedule:** 8 Hr (3:00 PM - 11:30 PM) **Summary:** The Admissions Registration Specialist 2 is responsible for reviewing patient registration for all types of ... is complete and current with each patient visit. The Admissions Registration Specialist I will assist patients with understanding their insurance options and… more
- CareOregon (Portland, OR)
- …positions must reside in Oregon or Washington. Job Title Sr Compliance Specialist Exemption Status Exempt Management Level n/a Direct Reports n/a Manager Title ... must reside in Oregon or Washington. Job Summary The Sr Compliance Specialist is responsible for supporting administration of compliance processes within CareOregon.… more
- Trinity Health (Chelsea, MI)
- …and assignment of benefits required. Provides information to patients concerning regulatory requirements. At point of service, provides estimated costs and patient ... and processes are created. Maintains compliance with HIPAA and other regulatory requirements throughout all activities. Protects the safety of patient information… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …teams and Senior Account. Complies with Federal, State, Center for Medicare & Medicaid Services (CMS), National Committee for Quality Assurance NCQA and The Joint ... Professional Medical Staff Management (CPMSM) or Certified Professional Credentials Specialist (CPCS) by National Association of Medical Staff Services **or… more
- Trinity Health (Chelsea, MI)
- …and assignment of benefits required. Provides information to patients concerning regulatory requirements. At point of service, provides estimated costs and patient ... and processes are created. Maintains compliance with HIPAA and other regulatory requirements throughout all activities. Protects the safety of patient information… more
- City of New York (New York, NY)
- …across NYC. Additionally, the Office is responsible for managing a contract portfolio of community based behavioral health treatment, rehabilitation and support ... to, Assertive Community Treatment (ACT), Intensive Mobile Treatment (IMT), Non- Medicaid Care Coordination, Clubhouses, Assisted Competitive Employment programs for… more
- Trinity Health (Ann Arbor, MI)
- …of insurance and governmental programs, regulations and billing processes (Medicare, Medicaid , SSD, SSID), managed care contracts and coordination of ... and assignment of benefits required. Provides information to patients concerning regulatory requirements. At point of service, provides estimated costs and patient… more
- Northwell Health (Lake Success, NY)
- …care provided. Responsible for concurrent inpatient medical record reviews for Medicare, Medicaid and all commercial payers. Generates queries and have follow up ... logic, documentation opportunities, clinical documentation requirements, and compliance to regulatory and facility policies and procedures. 9.Conducts follow-up reviews… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …and procedures by following the ICD-10-CM, Uniform Hospital Data Set, Medicare, Medicaid , and other fiscal intermediary guidelines + Report trends and improvements ... claims departments including explanations for recovery of money and appropriate regulatory agencies + Educates provider services, claims, recovery, finance and other… more
- Rush University Medical Center (Oak Park, IL)
- …8 Hr (6:00:00 PM - 3:30:00 AM) **Summary:** The Admissions Registration Specialist Lead is responsible for reviewing patient registration for all types of ... information is complete and current with each patient visit. The Admissions Registration Specialist Lead is proficient in working in a multitude of WQs outside their… more