- 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 ... Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement ...new CPT and HCPCS codes for coding logic, related Medicare / Medicaid policies to make recommend reimbursement… more
- Guidehouse (El Segundo, CA)
- …from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare / Medicaid + Insurance Follow-up + Customer Service + Billing + UB-04 & ... You Will Do** **:** The **Insurance Patient Account Representative** **(Hospital Claims )** is an extension of a client's business office staff. Representatives… more
- Humana (Albany, NY)
- …The Senior Business Intelligence Engineer will develop and maintain expertise in Medicaid reimbursement methodologies rooted in complex grouping concepts (EAPG, ... Business Intelligence Engineer will be responsible for: Researching state-specific Medicaid reimbursement methodologies for hospitals and facilities Developing… more
- Humana (Boise, ID)
- …Senior Business Intelligence Engineer will develop and maintain expertise in complex Medicare reimbursement methodologies. This role is within the Integrated ... on Pricer edit resolution + Provide consultation to internal business partners on Medicare reimbursement /editing logic and Humana system logic **Use your skills… more
- Highmark Health (Buffalo, NY)
- …interpret data in government value-based reimbursement reports in the areas of Medicare STARS, Medicaid HEDIS and risk revenue and develop strategic plans to ... of primary care providers (PCP) enrolled in government value-based reimbursement programs and continuous improvement models. This job is...is a highly skilled subject matter expert (SME) in Medicare STARS, Medicaid HEDIS and risk revenue… more
- Molina Healthcare (ID)
- …their financial and clinical performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **JOB ... and manage information from large data sources. + Analyze claims and other data sources to identify early signs...- 5 years supervisory experience + Demonstrated understanding of Medicaid and Medicare programs or other healthcare… more
- AmeriHealth Caritas (Detroit, MI)
- …psychosocial needs. This role ensures that care is delivered by Centers for Medicare & Medicaid Services (CMS), state, and organizational guidelines, within the ... individuals with chronic conditions or disabilities. + Strong understanding of Medicare - Medicaid Plan Long-Term Services and Supports (MMP LTSS) programs.… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Medicaid Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and integrity of ... coordination of analytical processes, investigation and interpretation of Maryland Medicaid risk score methodology, risk score calculation, submissions, enrollment,… more
- Hartford HealthCare (Farmington, CT)
- …timely and accurate collection of third-party payers, resolving outstanding insurance claims across all Hartford HealthCare hospitals, medical group and homecare. ... Provides input on decisions that affect workflows effecting timely resolution of insurance claims . 4. Provides support for other ad hoc analyses and projects as… more
- Humana (San Juan, PR)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... caring community and help us put health first** The Claims Review Representative makes appropriate claim decision based on...employment + Generous Paid Time Off accrual + Tuition Reimbursement + Parent Leave **Work at Home Requirements** +… more
- TEKsystems (Tampa, FL)
- … Processing, Refunds/ Reimbursement , Provider Relations, etc. + Experience working all claims : Medicare , Medicaid , Commercial, and Workers Comp + Medical ... -Refund Processing: Handle refund requests, including overpayment analysis and reimbursement facilitation. - Claims Research & Resolution: Investigate… more
- Dignity Health (Bakersfield, CA)
- **Job Summary and Responsibilities** The Claims Recovery Manager is responsible for leading the recovery operations within the MSO Claims department. This role ... or GED + Minimum 5 years of progressive experience in healthcare claims recovery, payment integrity, or post-payment audit functions, preferably within a multi-plan… more
- Waystar (Louisville, KY)
- …1K+ hospitals and health systems, and is connected to over 5K commercial and Medicaid / Medicare payers. We are deeply committed to living out our organizational ... of hospital & professional coding and billing workflows and the provider reimbursement process, obtained either through direct experience in a healthcare setting or… more
- Abbott (Austin, TX)
- …and appeal processes and other related matters requiring a specialized knowledge of Medicare , Medicaid and Private Payer reimbursement procedures and ... ** is responsible for implementing and managing clinical trial reimbursement processes to secure Medicare and private...On** + Review clinical investigative plan and payer policies ( Medicare , Medicare Advantage, Medicaid and… more
- CareFirst (Baltimore, MD)
- …such as auditing of contracts, responses to RFI/RFPs, researching Medicare , Medicaid and other industry policies and reimbursement methodologies. Compile fee ... maty be responsible for preparing analyses associated with the development of reimbursement policy, strategies, cost of care impacts and work flows for healthcare… more
- J&J Family of Companies (Tucson, AZ)
- …approval processes and business acumen + Understanding of Medicare , Medicaid , and private payer initiatives affecting reimbursement of pharmaceutical and ... assigned. Educate HCPs on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and coding requirements of… more
- J&J Family of Companies (Fresno, CA)
- …approval processes and business acumen. + Understanding of Medicare , Medicaid , and private payer initiatives affecting reimbursement of pharmaceutical and ... + Educate HCPs on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and coding requirements of… more
- J&J Family of Companies (Manchester, NH)
- …approval processes and business acumen. . Understanding of Medicare , Medicaid , and private payer initiatives affecting reimbursement of pharmaceutical and ... . Educate HCPs on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and coding requirements of… more
- Fairview Health Services (Minneapolis, MN)
- …Medical Billing + 3 years Three+ years medical billing or collection experience, Medicare , Medicaid , Third Party experience + Pharmacy Technician MN Certified ... Ensure accurate and timely billing, collections, appeal of home infusion claims . Perform collection tasks to obtain payments. Analyze accounts for documentation,… more
- Danaher Corporation (Portland, OR)
- …and reimbursement landscape. + Communicate regional and local coverage and reimbursement issues for Medicare , Medicaid and Commercial payers through ... and reimbursement . + Support customers with approved resources for denied claims , payer coverage expansion and inadequate reimbursement . + Respond to and… more