- Teva Pharmaceuticals (Parsippany, NJ)
- Medicaid Claims Analyst Date: Oct 21, 2024 Location: Parsippany, United States, New Jersey, 07054 Company: Teva Pharmaceuticals Job Id: 57268 **Who we are** Teva ... us on our journey of growth! **The opportunity** The Medicaid Claims Analyst is responsible for ... analyzes and documentation on assigned states/programs. Communicate to manager for key findings and changes to state programs.… more
- Guidehouse (Lewisville, TX)
- …from home._** **_Questions regarding this position, you may contact Chris Rivera ( Manager , Talent Acquisition) 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… more
- CVS Health (Columbus, OH)
- …affordable. **Position Summary** Reviews, analyzes, negotiates, and executes complex Medicaid contracts with health systems, physician groups, and behavioral health ... liaison to internal colleagues to interpret contracts, drive cost savings, resolve claims and other service issues. **Required Qualifications** + 7-10 years work… more
- New York State Civil Service (New York, NY)
- …for defrauding New York state out of more than $4 Million in false Medicaid claims .Duties: * Assisting with screening and evaluating complaints of abuse and ... Attorney General, Office of the Title Legal Nurse: Medical Analyst Support Medicaid Fraud Cases (6345) Occupational Category Legal Salary Grade NS Bargaining Unit… more
- Humana (Indianapolis, IN)
- …The Provider Education & Outreach Representatives serve as the primary relationship manager with providers to ensure positive provider experience with Humana Healthy ... policies and procedures, explain Humana systems, etc. + Serves as primary relationship manager with LTSS and HCBS providers and/or PH and BH providers to ensure… 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 ... dedicated team of claims examiners, auditors, and support staff, and monitor the...American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) coding guidelines such as the National… more
- Apex Health Solutions (Houston, TX)
- Summary: Position is responsible for oversight of claims adjudication and regulatory reporting functions including all associated processes, reporting of key ... also responsible for the timely processing and accuracy of claims and day to day interactions with any vendor...of health insurance industry with all product lines (Medicare, Medicaid , Commercial, ASO, DSNP, etc ) Extensive knowledge of… more
- Elevance Health (Topeka, KS)
- …and use of proprietary data and claim systems for review of Kansas Medicaid claims . + Responsible for independently identifying and developing enterprise-wide ... to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Cincinnati, OH)
- …network physicians. + Prepares and implements custom medical necessity criteria for Medicaid business to meet State contract requirements + Support the health plan ... pharmacists to introduce efficiencies or improved criteria documents based on claims issues, complaints, state recommendations or audits. + Coordinates with internal… more
- Elevance Health (Tampa, FL)
- RN Utilization Management Nurse Sr. ( Medicaid -InPatient) JR130851 **Location:** Must be within 50 miles / 1 hour commute of Tampa or Miami, FL offices. This is ... Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied. Primary duties may… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Accounting Clerk (Commercial Claims Follow-up) Full-Time M-F 9AM to 5PM East 42nd Street** Under the supervision of the Patient Financial ... Supervisor/ Manager , performs a variety of patient accounting functions, including...including but not limited to financial verification, preparation of Medicaid applications, billing, processing accounts, payment and/or charge posting,… 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...the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the… more
- University of Washington (Seattle, WA)
- …participate in on-the-job training thus the employee must possess superior claims management knowledge and skills, support learning and development opportunities for ... **PRIMARY JOB RESPONSIBILITIES** + Work timely and accurately in assigned claims follow-up queues and other assignments. + Accurately decipher denial reason… more
- Prime Therapeutics (Columbus, OH)
- …fuels our passion and drives every decision we make. **Job Posting Title** Claims Technical Analyst, Sr. **Job Description** The Senior Claims Technical Analyst ... is responsible for serving as the claims analysis resource for assigned operations teams. This role...with Medicare Part D and Centers for Medicare and Medicaid Services rules and regulations **Preferred Qualifications** + Training… more
- Marshfield Clinic (Marshfield, WI)
- …to support the most exciting missions in the world!** **Job Title:** Claims Examiner I (Remote/Hybrid Option) **Cost Center:** 682891379 SHP- Claims **Scheduled ... am - 5:00 pm (United States of America) **Job Description:** **JOB SUMMARY** The Claims Examiner I is responsible for examining claims for accurate processing… 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 ...with County Social Security Office supervisor to ensure all claims are processed correctly and rapidly. + Work with… more
- Fallon Health (Worcester, MA)
- …be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the Elderly)- in ... Under the general direction of the Senior Internal Audit Manager , theAnalyze and interpret patient medical records pertaining to...to FWA investigations Compare to information submitted on the claims in order to determine amount and nature of… more
- The Wesley Community (Saratoga Springs, NY)
- …produce all Wesley primary billing for Medicare, HMO, VA, MLTC as well as secondary Medicaid claims monthly. + Prepare/submit Wesley Medicare no pay claims ... to Medicare on a monthly basis. + Prepare/submit Wesley Medicaid claims weekly. + Enter all Wesley Hospice admissions and discharges into MyUnity. + Make billing… more
- Kepro (Albany, NY)
- …including coaching and mentoring and performance reviews + Strong knowledge in Medicaid Management Information System around Claims processing and related ... a hybrid role based in Albany NY Acentra is looking for a Business Analyst Manager to join our growing team. Job Summary: Business Analyst Manager is responsible… more
- Intermountain Health (Murray, UT)
- **Job Description:** The Pharmacy Services Manager provides leadership and direction to SelectHealth Pharmacy Services and SelectHealth Prescriptions. This position ... contributes to the strategic and clinical direction of the department. The Manager identifies and promotes the changes needed to provide cost-effective quality… more