- Guidehouse (Lewisville, TX)
- …at ###_** **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 patients in all requested… 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
- UCLA Health (Los Angeles, CA)
- Description We are seeking a detailed-oriented and experienced Claims Manager to join our Claims leadership team. In this key role, you will oversee a ... preferred or equivalent work experience, preferred + 5 years previous experience in claims operations specifically related to Medicare Advantage or managed care… more
- St Croix Hospice (Oakdale, MN)
- …payables for facilities into the accounting system + Accurately processes and bills Medicaid , private payer and patient claims in accordance with payer ... preparation of monthly billing and accounts receivable reports. + Maintains accurate Medicare and Medicaid accounts receivable analysis reports. + Maintains… more
- CenterLight Health System (NY)
- JOB PURPOSE: The Senior Project Manager , Claims Payment Integrity supports the Senior Vice President and the Director in the day-to-day operations of the ... Claims Operations Department. The position performs and delivers accurate...Experience with project management. + Industry level knowledge of Medicaid and Medicare rules, regulations, and processes.… more
- The Cigna Group (Bloomfield, CT)
- The Claims Strategy and Payment Integrity Senior Manager will play an important role in our Affordability strategy by providing claim payment oversight for the ... IFP claim administration activities against current industry policies/standards (especially IFP/ Medicare / Medicaid ). Additionally, this individual will lead a… more
- Apex Health Solutions (Houston, TX)
- …experience Strong knowledge of health insurance industry with all product lines ( Medicare , Medicaid , Commercial, ASO, DSNP, etc ) Extensive knowledge of ... Summary: Position is responsible for oversight of claims adjudication and regulatory reporting functions including all...also responsible for the timely processing and accuracy of claims and day to day interactions with any vendor… more
- MD Anderson Cancer Center (Houston, TX)
- …denied claims 3. Epic billing/EMR system experience 4. Thorough understanding of Medicare , Medicaid , Managed Medicare /Managed Medicaid and their ... the PBS Associate position is to follow-up on billed claims within regulatory guidelines. The PBS Associate must ensure...service. 4. Identifies denial trends and notifies Supervisor and/or Manager to prevent future denials and further delay in… 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
- Fallon Health (Worcester, MA)
- …+ Seeks intermittent assistance from Team Subject Matter Experts (SMEs), the Trainer and Claims Manager to ensure accuracy of adjudicating claims and to ... **Overview** **The Claims Examiner position is a hybrid role working...be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid , and PACE (Program of All-Inclusive… more
- BrightSpring Health Services (Arlington, TX)
- …in obtaining information completing necessary documentation or following up on outstanding claims + Individual with an understanding of Insurance and Medicaid ... as assigned + 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 + Provide clinical support to members of the… 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 ... want to join an organization that invests in you as a Medical Insurance Claims Representative? At HCA Healthcare, you come first. HCA Healthcare has committed up to… more
- Humana (Columbus, OH)
- …degree in Business, Finance, Operations or other related fields or 3+ years with Medicare and/or Medicaid claims processing or auditing experience + 2+ ... to ensure successful submission and reconciliation of encounter submissions to Medicaid / Medicare . Ensures encounter submissions meet or exceed all compliance… more
- Elderwood (Lockport, NY)
- Salary $22.40 - $33.60 / hour Overview Business Office Manager Overview The Business Office Manager is responsible for billing and collection of private pay ... applicable), and receptionist positions (where applicable). Responsibilities Business Office Manager Essential Job Functions + Handles establishment, transactions, record-keeping,… 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
- University of Rochester (Rochester, NY)
- …resolution and adjudication, including refund of credits + Review and advise supervisor or manager on trends of incorrectly paid claims from specific payers + ... as to the processes necessary to collect denied insurance claims and resolve billing issues. Must track payer/billing issues...of reports: + 2 nd insurance level report + Medicare and Medicaid credit balance report +… 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 ... or related field; or equivalent relevant experience. + Experience with Medicare and Medicaid and/or health insurance, a plus. **License/Certifications:**… more
- Kepro (Albany, NY)
- …+ Minimum 5+ years of experience on large complex project Domain knowledge of Medicare Medicaid and/or healthcare verticals. + Minimum 5+ years of business ... analysis experience in Healthcare Domain knowledge with good knowledge on Medicare / Medicaid - Provider Management and Enrollment System experience. + Minimum 4+… more
- LA Care Health Plan (Los Angeles, CA)
- …and health care claims Knowledge of Risk Adjustment models (eg CMS Medicare Advantage, HHS-HCC, Medicaid DxCG) Extensive knowledge of healthcare industry, ... Manager , Analytics Job Category: Accounting/Finance Department: Risk Adjustment Strategies & Initiatives Location: Los Angeles, CA, US, 90017 Position Type: Full… more
- Commonwealth Care Alliance (Boston, MA)
- …in a managed care organization preferred **Knowledge, Skills & Abilities (Required)** + Medicare and Medicaid managed care experience + Demonstrated knowledge of ... Proj Mgmt Office **Position Summary** The Enterprise Senior Project Manager is a key project delivery leadership role in...of audiences + Experience with managing clinical services for Medicaid / Medicare patients + Demonstrated ability to lead… more
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