- Sedgwick (Columbus, OH)
- …of complex clinical data; to complete complex submissions revisions/updates in preparation for Medicare review and act as an internal resource regarding Centers ... and practice guidelines. + Reviews medical claims and completes complex file review for Medicare Set- Asides (MSA) and future medical cost projections. + Serves… more
- CommuniCare Health Services Corporate (Indianapolis, IN)
- …check forms and audit for accuracy per triple check policy prior to claims submission + Review of Medicare A, Medicare A No Pays/Benefit Exhaust, Medicare ... Medicare Biller The CommuniCare Family of Companies currently...living communities. CommuniCare Health Services is currently recruiting a Medicare Biller for our Central Billing Office in Cincinnati,… more
- Point32Health (Canton, MA)
- …bid filing, timely and accurate response to CMS questions that may arise during desk review , review of Medicare Plan Finder (MPF) for accuracy, etc. + ... Manager will play a key role in the document creation/ review process to ensure that all communication materials reflect...of each market. All responsibilities extend to any new Medicare markets should Point32Health choose to expand its footprint… more
- Guidehouse (Lewisville, TX)
- …Lewisville, TX office and three days from home._** **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… more
- AdventHealth (Calhoun, GA)
- …insured and, if so, gathers details (eg, insurer name, plan subscriber) * Performs Medicare compliance review on all applicable Medicare accounts in order ... patients * Verifies medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility… more
- AdventHealth (Hinsdale, IL)
- …insured and, if so, gathers details (eg, insurer name, plan subscriber) + Performs Medicare compliance review on all applicable Medicare accounts in order ... patients + Verifies medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility… more
- The Cigna Group (Houston, TX)
- …for Medicare Part D Health Plans: PDP, MAPD, and Special Needs Program (SNPs) + Review Medicare Part D Plan bid assumptions for Regulated Medicare Part D ... Health Plans + Create analytics for Medicare Part D Bids substantiation for Desk Review and Medicare Part D audits + Utilize independent judgement and… more
- Health First (Melbourne, FL)
- …and secure the required forms to meet compliance with regulatory policies. 3. Perform Medicare compliance review on all applicable Medicare accounts in order ... to determine coverage. Identify patients who may need Medicare Advance Beneficiary Notices of Noncoverage (ABNs). Issues ABN forms as needed. 4. Complete Medicare… more
- PruittHealth (Norcross, GA)
- …. Direct all aspects of reimbursement operations, reporting, rate setting, and Medicare bad debt review for PruittHealth's healthcare facilities and services. ... in reimbursement regulations. . Manage the preparation, submission, and review of accurate and timely Medicare and...submission, and review of accurate and timely Medicare and Medicaid reports. Analyze results and implement strategies… more
- University of Rochester (Strong, AR)
- …patients COBRA entitlement and assist with paperwork if necessary. **Compliance** + Review Medicare for MSP questions and validations. Investigates and corrects ... to authorizations, coordination of benefits, baby not on policy, Cobra entitlement, Medicare Lifetime Reserve days, and Medicare Advantage issues. This role… more
- University of Rochester (Rochester, NY)
- …audits, and third-party payor audits - Coordinate responses and resolution to Medicaid and Medicare credit balances- - - Review all accounts on the Medicaid and ... Excel, Access, Email, Emdeon (Fidelis Medicaid Managed Care and Medicare Part B) clearinghouse software, third party claims systems...resolution and adjudication, including refund of credits - - Review and advise supervisor or manager on trends of… more
- University of Rochester (Rochester, NY)
- …audits, and third-party payer audits. - Coordinate responses and resolution to Medicaid and Medicare credit balances- - - Review all accounts on the Medicaid and ... resolution and adjudication, including refund of credits - - Review and advise supervisor or manager on trends of...reports:- - - 2nd insurance level report - - Medicare and Medicaid credit balance report - - Over… more
- University of Rochester (Rochester, NY)
- …audits, and third-party payer audits. - Coordinate responses and resolution to Medicaid and Medicare credit balances- - - Review all accounts on the Medicaid and ... resolution and adjudication, including refund of credits - - Review and advise supervisor or manager on trends of...the account to a self-pay financial class after a review of previous efforts has not resulted in revenue… more
- Commonwealth Care Alliance (Boston, MA)
- …research, as necessary on all new and revised coding logic, related Medicare /Medicaid policies for review /approval through the Payment Integrity governance ... ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also...Optum CES and Zelis edits. + Quarterly and Annual review and research, as necessary on all new CPT… more
- Alameda Health System (Alameda, CA)
- …is documented and a resolution is initiated and presented weekly at Medicare or Utilization Review meetings. **MININUM QUALIFICATIONS** : Education: Graduate ... Assigns, assists, and instructs all staff in the RAI Process, Case-Mix, PPS Medicare , Medicaid, and the clinical computer system in relation to these processes. 8.… more
- New York State Civil Service (New York, NY)
- … review experience in a health care facility regulated by Centers for Medicare and Medicaid Services Utilization Review Standards, or* Possession of a license ... NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), Manhattan Psychiatric Center, P25289 Occupational Category Health Care,… more
- Molina Healthcare (San Jose, CA)
- …legal research, contract law, healthcare law, law, corporate law, healthcare, Medicare , Medicaid, contract review , LexisNexis, iManage, contract drafting, ... least 3 years of managed healthcare experience with an understanding of Medicare , Medicaid, and Marketplace (multistate experience preferred). + Must be proficient… more
- Medical Mutual of Ohio (OH)
- …remediation efforts for Hospice and End Stage Renal Disease (ESRD) processes. . Supports Medicare Pharmacy Specialists in the research and review of Part D and ... providing confirmation of compliance to internal team. . Supports Medicare Pharmacy Specialists in the research and review... Medicare Pharmacy Specialists in the research and review of Part D and Part B inquiries, grievances,… more
- HCA Healthcare (Kansas City, MO)
- …Line for the Division 7 days per week for Inter-Qual questions related to Medicare review processes. **What qualifications you will need:** + RN Graduation from ... a school of nursing. Bachelors' degree preferred. For Social Worker, Masters of Social Work (MSW) degree required. + Current RN license for the state of Missouri. + Minimum 5 years case management experience required. Research Medical Center… more
- Elevance Health (Columbus, OH)
- **Audit & Reimbursement III - Medicare Cost Report Audit** **_Locations:_** _This is a virtual United States based position._ **National Government Services** is a ... Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare...directed by management. + Participates in special projects and review of work done by auditors as assigned. +… more
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