- Commonwealth Care Alliance (Boston, MA)
- …and medical coding (CPT, HCPCS, Modifiers) along with the application of Medicare /Massachusetts Medicaid claims ' processing policies, coding principals and ... ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role...Management + Collaborate system and data configuration into CES ( Claims Editing System) with BPaaS vendor and… more
- Humana (Boise, ID)
- …on Pricer edit resolution + Provide consultation to internal business partners on Medicare reimbursement/ editing logic and Humana system logic **Use your skills ... closely with IT, the pricing software vendor, CIS BSS, claims operations, and other business teams involved in the...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
- Healthfirst (NY)
- …SharePoint + Knowledge of at least two or more lines of business such as NY Medicare , Medicaid , Family Health Plus, Child Health Plus WE ARE AN EQUAL OPPORTUNITY ... + Conduct moderately complex to complex quality audits of provider claims , pre-payments and post-payments including high-dollar and specialized claims … more
- Humana (Raleigh, NC)
- …by reading and interpreting claims + Exceptional understanding of Centers for Medicare & Medicaid Services (CMS) guidelines, state Medicaid guidelines, ... (CEVM) contributes to overall cost reduction by utilizing code editing guidelines and data anomalies to ensure correct claim...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
- Primary Health Care (Des Moines, IA)
- …billing requirements. + Experience working with dental/medical insurance contractual agreements, Medicare and Medicaid regulations, payment and recoupments. + ... payment posting and follow up of medical and/or dental claims on behalf of PHC. Provides work direction and...the timely submission of all clinic charges and daily editing , ensuring appropriate coding, pay codes, etc. Ensures compliance… more