- CVS Health (Hartford, CT)
- …anywhere in the US.** Responsibilities of this Medical Director role are related to Regulated Medicare Appeals : * Direct daily work on part C appeals (both ... policy for the enterprise. * Provide ongoing education regarding Medicare policy and appeals to the appeal nurses and territory Utilization Management staff. *… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …issues and submit cases to appropriate area for review. . Facilitates processing of Medicare appeals to the independent review entity (IRE) . Documents IRE ... experience, training and education. . 5 years as an Appeals Specialist or equivalent experience in Medicare ...an Appeals Specialist or equivalent experience in Medicare health insurance claims, customer service, billing or related… more
- Centene Corporation (Jefferson City, MO)
- …policies and standards **Registered Nurse with behavioral health and Medicare appeals experience preferred.** **Education/Experience:** Requires Graduate from ... **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical… more
- Humana (Columbus, OH)
- …clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Possess analysis and interpretation ... are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. **Equal… more
- VNS Health (Manhattan, NY)
- …state and federal regulatory requirements related to all aspects of grievances and appeals for Medicare managed care organizations, Medicaid, home health care, ... OverviewResolves grievances, appeals and external reviews for VNS Health Plans...Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Fully Integrated Dual Advantage (FIDA) and… more
- Molina Healthcare (Columbus, OH)
- …of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory ... with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research… more
- Guidehouse (Lewisville, TX)
- …(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 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… more
- CVS Health (New Albany, OH)
- …as a mentor to other analysts. **Required Qualifications** - Advanced knowledge of Medicare appeals process and the associated processing system - 7 or more ... Consultant is responsible for the analyzing issues related to appeals and related areas. One should be proficient in...one or more of the following skillsets: data analysis, Medicare compliance, Aetna clinical policy - **AND** ability to… more
- NJM Insurance (Hammonton, NJ)
- …responds timely. + Maintain up-to-date knowledge on Section 111 reporting and the Medicare Appeals Process to include seminars, monitoring the CMS website and ... following the best practices associated with managing all aspects of the Medicare recovery process and healthcare liens more effectively and efficiently. The… more
- Medical Mutual of Ohio (OH)
- …new or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals , Grievances, and Medicare marketing material requirements. . Assists ... new or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals , Grievances, and Medicare marketing material requirements. . Assists… more
- US Tech Solutions (May, OK)
- …volume where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government ... requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided through multiple channels… more
- US Tech Solutions (May, OK)
- …volume where needed. **Responsibilities:** Utilizing multiple software systems to complete Medicare appeals case reviews Meeting or exceeding government mandated ... requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided through multiple channels… more
- US Tech Solutions (May, OK)
- …volume where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government ... clients or lines of business and in accordance with Medicare Part D CMS Regulations. + Must apply information...coverage requests. + Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. +… more
- Baptist Memorial (Memphis, TN)
- Summary Medicare / Medicaid Appeals Registered Nurse reviews and evaluates medical documentation to support billing compliance and external regulatory ... of Hospital Revenue Cycle, CPT codes, HCPC codes, modifiers, and the Medicare /Medicaid Appeals Process. Familiarity of billing regulations including federal and… more
- UCLA Health (Los Angeles, CA)
- …skills, particularly in evaluating medical necessity * Thorough understanding of Medicare Advantage regulations, especially related to appeals , grievances, and ... Description As the Appeals & Grievances Nurse, you will play a...of medical care and services rendered in relation to Medicare guidelines, compliance requirements, and internal policies. + Identifying… more
- Robert Half Accountemps (Durham, NC)
- …team. This role is situated within the healthcare industry, specifically dealing with Medicare Advantage Member appeals from providers. The workplace is based in ... skills, with a focus on Quality Assurance * Familiarity with HealthCare.gov and Medicare policies * Proven experience in handling Appeals and understanding… more
- Astrix Technology (Westchester County, NY)
- …audits; investigate and resolve denied claims in a timely manner, including Medicare appeals , re-openings, and reconsiderations. + Manage credentialing with ... 3 years of experience in medical billing, specifically with NYS Medicaid, Medicare , and commercial insurance plans. This role requires proficiency in processing… more
- Kelsey-Seybold Clinic (Houston, TX)
- …appropriate timeframes. This position will serve as a liaison to the Grievance and Appeals Department for Medicare Advantage appeals . The Utilization Review ... based on Texas Department of Insurance (TDI) and or Centers for Medicare and Medicaid (CMS) and healthplan requirements. The Utilization Review Specialist (LVN)… more
- Mohawk Valley Health System (Utica, NY)
- …clinical variability throughout the medical staff. + Assist case managers with Medicare and Medicaid appeals and Administrative Law Judge (ALJ) testimonies. ... prevent denials or carved out days when appropriate. Provide telephonic and written appeals as requested for commercial payors. + Perform reviews and appeals .… more
- Novant Health (Winston Salem, NC)
- …maintains knowledge of processes such as petitioning for guardianship and navigating the Medicare appeals process. + Willingness to cross train between Inpatient ... and Emergency Departments to assist during periods of need. + Communicates individualized plan of care and patient's progress toward goals to all members of the care team including the patient and his/her chosen support system/legal guardian/Care Coordinator.… more