- Randstad US (Franklin, TN)
- edi scrum master (hipaa - medicare / medicaid , edi - itxa, sterling) - franklin,tn. + franklin , tennessee + posted 6 days ago **job details** summary + $45 - $55 ... Mapper, Performance Tuning, Production Support ANSI X12 HIPAA: 837 Claims (Institutional, Dental, Professional), 835 (Claim Payment/Remittance), 834 (Benefit… more
- Fallon Health (Worcester, MA)
- …strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid , and PACE (Program of All-Inclusive Care for the ... define Coding Standards and best practices. Accept assignment from the Manager . Maintain strong interdepartmental relationships. Light travel may be required.… more
- Guidehouse (Lewisville, TX)
- …at ###_** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare / Medicaid + Insurance Follow-up + Customer Service + Billing + UB-04 & ... appeals & denials. **What Would Be Nice To Have** **:** + Has active Medicare appeal process experience + PC skills in a Windows environment are required. Knowledge… more
- Medical Mutual of Ohio (OH)
- …a health plan, pharmacy, or PBM operations, which includes exposure to Centers for Medicare & Medicaid Services (CMS) guidelines, preferably Part D. . Certified ... Medicare Part D (pharmacy). . Knowledge of pharmacy claims processing through retail or mail pharmacy. . Intermediate...or PBM operations, which includes exposure to Centers for Medicare & Medicaid Services (CMS) guidelines, specifically… more
- Consulate Health Care (Norfolk, VA)
- …Health Care of Norfolk | Full Time **Looking for qualified Assistant Business Office Manager ( Medicaid Specialist) to join our team at the Consulate Health Care ... Norfolk!** We are searching for an **Assistant Business Office Manager ** to join our community that is resident and...the generation and submission of all network and insurance, claims , statements on a timely basis. + Produce UB92's… more
- Humana (Indianapolis, IN)
- …for TB. **Preferred Qualifications** + Bachelor's Degree. + Experience with Indiana Medicaid and Medicare Advantage guidelines. + Understanding of managed care ... efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large.… more
- Dignity Health (Bakersfield, CA)
- …employer-match. Other benefits include Paid Time Off and Sick Leave. **Responsibilities** Assist Claims Manager in day to day supervision, support and monitoring ... the work in progress based on findings. This position reports to the Claims Manager . This position has supervisory responsibility over several Claims… more
- Trinity Health (Atlanta, GA)
- …stipulations. + Generate Aging Reports, follow up on overdue accounts and rejected claims . + Notify the Department Director or Manager as necessary regarding ... research and resolve payment discrepancies. + Experience in physician offices with Medicare / Medicaid exposure is a plus. **Position Highlights and Benefits:** +… more
- CHS (Clearwater, FL)
- …related to claims and calls and provides feedback to their Manager . + Maintains up-to-date working knowledge on regulatory requirements associated with billing ... **Overview** ** ** ** Claims and Call Auditor (Call Center QC) -...+ Knowledge of medical coding systems + Knowledge of Medicaid / Medicare Guidelines + Knowledge of billing rules… more
- Fallon Health (Worcester, MA)
- …strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid , and PACE (Program of All-Inclusive Care for the ... Adjustment Analyst (RAA) will be to function as the Claims SME for the Risk Adjustment & Analytics Department....as assigned by the Risk Adjustment Operations and Analytics Manager and will be a SME for the risk… more
- HealthEdge Software Inc (Columbus, OH)
- …ACO/IDN, hospital, or healthsystem + Experience with government plans/program such as Medicare , Medicaid , Duals + Master's degree in Business or Healthcarefield ... **Overview** **Position** **Overview:** As a Senior Product Manager , within theclaimsvalue stream forHealthRulesPayor, you will have ownership of system… more
- HCA Healthcare (Denver, CO)
- …act as a liaison and administer contracts in collection of third party accounts ( Medicare and Medicaid ) + You will complete account reconciliation of accounts ... range. **Introduction** Do you have the career opportunities as a Medical Insurance Claims Representative you want with your current employer? We have an exciting… more
- BrightSpring Health Services (Arlington, TX)
- …obtaining information, completing necessary documentation, and following up on outstanding claims . + Understands Insurance and Medicaid formularies and ... authorization concerns + Achieves productivity goals with regard to calls/ claims per hour, as determined by the Director and...hour, as determined by the Director and Clinical Hub Manager . + Prioritizes work to meet daily and competing… more
- Prime Therapeutics (Columbus, OH)
- …with RxClaim + Pharmacy Technician Certification preferred + Previous experience with Medicare or Medicaid **Minimum Physical Job Requirements** + Must be ... and drives every decision we make. **Job Posting Title** Supervisor Operations, Claims Research - Remote **Job Description** The Supervisor Operations is responsible… more
- BrightSpring Health Services (Englewood, CO)
- Our Company Amerita Overview Reporting to the Reimbursement Compliance Project Manager of the RCM Team, the Claims Escalation Specialist/Team oversees ... accountability to effectively deliver results. + Knowledge and understanding of Medicare , Medicaid , and Commercial policies, processes, systems, pricelists,… more
- Commonwealth Care Alliance (Boston, MA)
- …Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Medical/BH Reimbursement Policy Manager will have overall responsibility ... project manager for: (1) regulatory information such as proposed and final Medicare and/or Medicaid payment regulations, Medicare Manual updates, DHHS… more
- MyFlorida (Largo, FL)
- …years of experience in third party billing in a clinical related environment including Medicare , Medicaid , and Commercial Insurers + Three (3) years knowledge of ... HEALTH OPERATIONS MANAGER - SES - 50000237 Date: Sep 19,...third party billing in a long-term healthcare environment including Medicare , Medicaid , and Commercial Insurers and related… 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 ...regards to accounts + Collections of all payors; Hospice, Medicare , Medicaid , MLTSS, Managed Care/Managed Medicare… more
- Hackensack Meridian Health (Hackensack, NJ)
- …and manages EPIC's Contract Management Module for professional Physician negotiated contracts, medicare and medicaid fee schedules and all other contractual ... a leader of positive change. The **Physician Enterprise/ Network Manager - Patient Accounts** is responsible for pre-billing and...out of state Medicaid , Charity Care & Medicaid , and Worker's Compensation and No Fault claims… more
- University of Rochester (Rochester, NY)
- …Word, Excel, Access, Email, Emdeon (Fidelis Medicaid Managed Care and Medicare Part B) clearinghouse software, third party claims systems (ePaces, Omnipro) ... refund of credits + Review and advise supervisor or manager on trends of incorrectly paid claims ...Supervisor and or Manager . Assist Supervisor with Medicare and Medicaid credit balance audits, and… more
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