- UCLA Health (Los Angeles, CA)
- …deadlines effectively due to the time constraints imposed by CMS on Medicare appeals and grievances. + Collaborates closely with beneficiaries, healthcare ... Description As the Appeals and Grievances (A&G) Analyst , you...addressed in a timely manner. + Analyze and process appeals and grievances in accordance with CMS/ Medicare … more
- UCLA Health (Los Angeles, CA)
- …deadlines effectively due to the time constraints imposed by CMS on Medicare appeals and grievances. + Collaborates closely with beneficiaries, healthcare ... Description As the Appeals and Grievances (A&G) Analyst , you...addressed in a timely manner. + Analyze and process appeals and grievances in accordance with CMS/ Medicare … more
- UCLA Health (Los Angeles, CA)
- Description As the Senior Appeals and Grievances Analyst , you will be responsible for: + Assisting with all operational aspects of appeals and grievances, in ... within UCLA Health, and external partners/vendors. + Analyze, investigate, and process appeals and grievances in accordance with CMS/ Medicare regulations and… more
- Travelers Insurance Company (Tampa, FL)
- …+ Compare bill and rates with appropriate fee schedules, clinical edits, Medicare , National Correct Coding Initiative (NCCI), internal Travelers protocols and PPO ... + College degree preferred and /or equivalent work experience. + Previous Appeals experience reviewing workers compensation medical bills highly desirable. + Solid… more
- Vanderbilt University Medical Center (Nashville, TN)
- …position upon cost report audit, reviews audit adjustments for reopening opportunities, and appeals disputed issues from the annual Medicare Cost Report and ... Reimb/Acct **Job Summary:** The primary purpose of the financial analyst is to support and perform analyses of financial...of financial matters related to reimbursement, net revenue and Medicare cost reporting. The work performed by this role… more
- CareFirst (Owings Mills, MD)
- …area in order to travel into local offices.** **PURPOSE:** The Senior Business Analyst to support our ** Medicare Prescription Payment Plan (M3P)** functions will ... Terminations + Process for handling overdue monthly bills + Dispute Handling ( Appeals and Grievances) + Data Submission Requirements (CMS reporting) The incumbent is… more
- City and County of San Francisco (San Francisco, CA)
- …more about what this commitment looks like in action. The Program Support Analyst , under the guidance of the Knowledge and Resource Manager within the Alignment ... Economic Support & Self Sufficiency (ESSS) initiatives. Additionally, the Program Support Analyst oversees and coordinates the policy needs for CalFresh and Medi-Cal… more
- CommonSpirit Health (Englewood, CO)
- …our hospitals and out in the community. **Responsibilities** The **Senior Reimbursement Analyst i** s responsible for providing cost report preparation, cost report ... appeals , audit preparation and other duties related to the...of Dignity Health. The position maintains current knowledge of Medicare , Medicaid and other State and Federal regulations. The… more
- Medical Mutual of Ohio (Toledo, OH)
- **_The Operations Data Analyst II position allows you the_** **_flexibility to work a hybrid schedule (on-site and at home)_** **_as long as you reside within a ... fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Medical Mutual' s… more
- State of Colorado (Grand Junction, CO)
- Board Certified Behavior Analyst (BCBA), (Clinical Behavioral Specialist II) - Grand Junction Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4726146) Apply Board Certified Behavior Analyst (BCBA), (Clinical Behavioral Specialist II) - Grand Junction… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Accounting and Reporting Analyst position is responsible for identifying and compiling information for various governmental reports, ... including Medicare & Medicaid Cost Reports, Annual Tax Returns, Federal...(HM) hospital and assists in cost report amendments, audit, appeals and reopening process. + Independently prepares federal and… more
- CVS Health (Austin, TX)
- …, Clinical Services is responsible for ensuring that any changes to Medicare Part D Coverage Determinations, Appeals , Organization Determination and CTM/GRV ... for complete and accurate processing of CD&A cases. The Analyst may work with account teams, implementation managers, business...configured correctly and tested in the operating system. The Analyst must be able to research and solve complex… more
- The Cigna Group (Bloomfield, CT)
- Nurse Case Management Lead Analyst -Nurse Clinician - Accredo Job Description Summary The Nurse Clinician - RN is responsible for reviewing escalated clinical ... policies. **JOB DUTIES:** + Conduct criteria reviews for commercial payers, Medicare , and Medicaid + Provide prior authorization assistance, and denial appeal… more
- Atrius Health (Chelmsford, MA)
- …policies and procedures responsible for responding to payer claim audits including Medicare program, writing complex clinical medical necessity appeals , analysis ... reviews for claim coding corrections and writing medical necessity related appeals . * Prior experience generating and interpreting data and reporting analysis… more
- Sanford Health (Grand Forks, ND)
- …**Salary Range:** $27.50 - $44.00 **Job Summary** The Senior Reimbursement Analyst provides critical analytical and reimbursement related guidance and support to ... functions including estimating, modeling and reimbursement functions, which includes Medicare , Medicaid or other third party cost reports, related audits,… more
- Cambridge Health Alliance (Cambridge, MA)
- PACE Health Plan Analyst Apply Refer a Friend Back **Date Posted:** 11/06/2024 **Requisition Number:** 8816 **Location:** CHA East Cambridge Care Center **Work ... The position also supports participant government program eligibility (MassHealth and Medicare ), as well as PACE business office functions. **Responsibilities:** +… more
- CareFirst (Baltimore, MD)
- …(RN) is to evaluate clinical quality and procedures within the Clinical Appeals & Grievance Department Government Programs (Maryland Medicare and Medicaid). ... and grievance management team. Collaborates with the training team, department business analyst , and the clinical appeals and grievance management team to… more
- LA Care Health Plan (Los Angeles, CA)
- …Center Compliance Audit Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: Full ... documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This position is… 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
- Health Advocates Network (Folsom, CA)
- Health Advocates Network is hiring a **Denials Analyst ** **(2 Years Exp Req)** ! This is a full-time contract position at a nationally recognized hospital located in ... and resolving claim denials, ADR requests, and certs, submitting and tracking appeals , noting trends, and providing monthly reports. Respond to audit requests… more