- Henry Ford Health System (Troy, MI)
- … Advantage, Medicare -Medicaid Program (MMP), and Medicaid lines of business. Analyst must identify trending issues on an ongoing basis and provide root/cause ... prompt and thorough investigation of medical and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): Commercial,...analysis when required. The Analyst will work with HAP's medical directors, nurses, pharmacists,… more
- OhioHealth (Columbus, OH)
- …Manager with updates. CGS audits and auditors Working with our legal vendor for Medicare Appeals . Working with OHA and CBSA facilities on wage index ... Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This position… more
- HCA Healthcare (Nashville, TN)
- …integrity. We care like family! Jump-start your career as a Benefits Operations Analyst today with HCA Healthcare. **Benefits** HCA Healthcare offers a total rewards ... location._** Come join our team as a Benefits Operations Analyst - Retirement Plans. We care for our community! Just...place comply with all regulations (Summary of Material Modification, Medicare Part D notices, privacy notices, etc.) + Manage… more
- Molina Healthcare (UT)
- …and contractual guidelines. + Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. + ... improvement. **Skills & Competencies** + Proven experience handling provider disputes, appeals , and overpayment recoveries in a managed care or payer environment.… more
- State of Colorado (Denver, CO)
- …Momentum referrals, obtaining identification, securing a payee, applying for Medicaid/ Medicare , and submitting referrals to potential discharge locations. + Must ... checks include + CBI & FBI fingerprint check, Colorado Court Database check, Medicare Fraud Database, TRAILS Database check. + This position will also provide direct… more
- State of Colorado (Pueblo, CO)
- …on Hospital Accreditation Standards, Environment of Care Manual, Centers for Medicare and Medicaid Services, Safety Data Sheets, Colorado State Personnel Procedure ... security personnel.) + CBI & FBI fingerprint check, Colorado Court Database check, Medicare Fraud Database, TRAILS Database check. + This position will also provide… more
- State of Colorado (Pueblo, CO)
- …on Hospital Accreditation Standards, Environment of Care Manual, Centers for Medicare and Medicaid Services, Safety Data Sheets, Colorado State Personnel Procedure ... security personnel.) + CBI & FBI fingerprint check, Colorado Court Database check, Medicare Fraud Database, TRAILS Database check. + This position will also provide… more
- CaroMont Health (Gastonia, NC)
- …medical record for clinical denials. Composes a detailed summary of care and sends appeals to MCO, Medicare , or RAC for reversal of original determination. May ... results. Maintains the Status Change Database. Performs retrospective clinical reviews/ appeals as part of denial process. The UR Specialist...be cross trained to work for the Commercial Resource Analyst when the need arises. Act as liaison to… more
- City and County of San Francisco (San Francisco, CA)
- …meet all of the following criteria: + Be eligible to participate in Medicare , Medicaid, and/or other federal healthcare programs + Possess a National Provider ... + Possess a valid third-party billable provider certification (such as Medicare , Medi-Cal, and/or private insurance) OR have submitted a completed billable… more
- State of Colorado (Denver, CO)
- …Background check: + CBI & FBI fingerprint check, Colorado Court Database check, Medicare Fraud Database, TRAILS Database check. + This position will also provide ... of state service experience. Minimum Qualification Screening Process A Human Resources Analyst will review the work experience/job duties sections of the online job… more
- State of Colorado (Aurora, CO)
- …name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure ... & Competencies: Minimum Qualification Screening Process A Human Resources Analyst will review the work experience/job duties sections of...if your application is eliminated. You will find the appeals process, the official appeal form, and how to… more
- State of Colorado (Jefferson County, CO)
- …name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure ... of state service experience. Minimum Qualification Screening Process A Human Resources Analyst will review the work experience/job duties sections of the online job… more
- State of Colorado (Denver, CO)
- …CBI name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks (Skill Survey), Professional License verification ... of state service experience. Minimum Qualification Screening Process A Human Resources Analyst will review the work experience/job duties sections of the online job… more
- State of Colorado (Denver, CO)
- …will not be accepted. Minimum Qualification Screening Process: A Human Resources Analyst will review the work experience/job duties sections of the online job ... checks + CBI name check, ICON Colorado court database, Medicare fraud database, Reference checks, Professional License verification (licensure requirements),… more
- State of Colorado (Fremont County, CO)
- …name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure ... & Competencies: Minimum Qualification Screening Process A Human Resources Analyst will review the work experience/job duties sections of...if your application is eliminated. You will find the appeals process, the official appeal form, and how to… more
- State of Colorado (Grand Junction, CO)
- …name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure ... of state service experience. Minimum Qualification Screening Process A Human Resources Analyst will review the work experience/job duties sections of the online job… more
- State of Colorado (Jefferson County, CO)
- …Medical Services Division (HFEMSD) of Department of Public Health (DPH); Centers for Medicare and Medicaid (CMS); CDHS Policies and Procedures; and other state and ... of state service experience. Minimum Qualification Screening Process A Human Resources Analyst will review the work experience/job duties sections of the online job… more
- State of Colorado (Denver, CO)
- …Background check: + CBI & FBI fingerprint check, Colorado Court Database check, Medicare Fraud Database, TRAILS Database check. + This position will also provide ... of state service experience. Minimum Qualification Screening Process A Human Resources Analyst will review the work experience/job duties sections of the online job… more
- State of Colorado (Pueblo, CO)
- …security personnel.) + CBI & FBI fingerprint check, Colorado Court Database check, Medicare Fraud Database, TRAILS Database check. + This position will also provide ... of state service experience. Minimum Qualification Screening Process A Human Resources Analyst will review the work experience/job duties sections of the online job… more
- State of Colorado (Garfield County, CO)
- …include : + CBI & FBI fingerprint check, Colorado Court Database check, Medicare Fraud Database, TRAILS Database check. + This position will also provide direct ... of state service experience. Minimum Qualification Screening Process A Human Resources Analyst will review the work experience/job duties sections of the online job… more