• Account Rep, Medicare -Iron County , Utah

    Molina Healthcare (St. George, UT)
    …the product choices available to them, the enrollment process (eligibility requirements, Medicare review /approval of their enrollment application, timing of ID ... for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare -Medicaid recipients within approved… more
    Molina Healthcare (10/05/24)
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  • Medical Billing Specialist ( Medicare

    Elderwood (Buffalo, NY)
    …Insurance, Medical, Dental, and Vision insurance Responsibilities Medical Billing Specialist ( Medicare /Managed Care): + Review remittances for potential denials, ... to providing exceptional care to our residents. Medical Billing Specialist ( Medicare /Managed Care) Position Overview: + Responsible for Managed Care and Insurance… more
    Elderwood (10/26/24)
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  • Manager, Actuarial Services - Medicare |

    Healthfirst (NY)
    …or any related degree + Experience in the actuarial field related to Medicare (bid development/ review , analysis, reporting, risk scores) + Ability to collect, ... **Duties and Responsibilities:** + Monitor experience under Healthfirst's Medicare line of business. + Provide support for... line of business. + Provide support for annual Medicare bids for all Healthfirst's Medicare products.… more
    Healthfirst (09/07/24)
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  • Chart Review Specialist - Medicare

    Fallon Health (Worcester, MA)
    …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... us on Facebook, Twitter and LinkedIn. **Responsibilities** The Chart Review Specialist primary responsibility is to review ,...Chart Review Specialist primary responsibility is to review , analyze and report on FCHP patient charts for… more
    Fallon Health (08/13/24)
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  • Medicare Biller / Accounts Receivable

    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
    CommuniCare Health Services Corporate (10/13/24)
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  • Sr Medicare Associate

    Sedgwick (Naperville, IL)
    Medicare Compliance system to determines appropriate course of action and acknowledge Medicare assignments and mail + Review and sort emails in Microsoft ... Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Sr Medicare Associate **PRIMARY PURPOSE** **:** To gather documentation required to complete… more
    Sedgwick (10/09/24)
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  • Patient Account Representative - Healthcare…

    Guidehouse (Lewisville, TX)
    …Chris Rivera (Manager, Talent Acquisition) at ###_** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare /Medicaid + Insurance Follow-up + ... appeals & denials. **What Would Be Nice To Have** **:** + Has active Medicare appeal process experience + PC skills in a Windows environment are required. Knowledge… more
    Guidehouse (10/07/24)
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  • Remote Utilization Review Nurse

    Actalent (Omaha, NE)
    …in medical review or utilization management. + Knowledge of utilization review , Medicare , utilization management, and EMR systems. Additional Skills & ... and preauthorization processing. This role involves accurate and timely medical review of claims, preauthorizations, and customer service inquiries. You will also… more
    Actalent (10/30/24)
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  • Consumer Access Specialist Outpatient Part Time

    AdventHealth (La Grange, 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
    AdventHealth (10/25/24)
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  • Medical Director - Pharmacy Appeals

    Humana (Columbus, OH)
    …help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work ... group practice management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or… more
    Humana (11/02/24)
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  • Patient Service Specialist PR - Outpatient Rehab

    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
    Health First (11/04/24)
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  • Medical Billing/Claims/Collections

    Robert Half Accountemps (Yukon, OK)
    …+ Process and submit medical claims to insurance providers, including Medicaid and Medicare . + Review and verify accuracy of billing information before ... of direct experience in medical claims or medical billing. + Medicaid and Medicare experience required. + Strong attention to detail and accuracy in processing… more
    Robert Half Accountemps (10/19/24)
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  • Sr Clinical Reimbursement Analyst - MDS RN

    Sanford Health (SD)
    …guidance and support to all operating segments across Sanford. Responsible to review Medicare /Medicaid documentation to assist nursing centers in completing ... minimum data set (MDS) documentation to assure appropriate levels of Medicare and/or Medicaid reimbursement. Works with executive leadership, administrators, and… more
    Sanford Health (11/01/24)
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  • Utilization Management Director (Hybrid)

    CareFirst (Baltimore, MD)
    …medical pre-authorization review , Commercial inpatient and outpatient behavioral health review , Medicare intake and medical pre-authorization review , ... Medicaid / Medicare intake, and Medicaid / Medicare medical pre-authorization review . More detail can be shared during the interview process. Plans,… more
    CareFirst (08/27/24)
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  • Clm Resltion Rep III, Hosp/Prv - Remote/Hybrid…

    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 ... Microsoft Word, Excel, Access, Email, Emdeon (Fidelis Medicaid Managed Care and Medicare Part B) clearinghouse software, third party claims systems (ePaces, Omnipro)… more
    University of Rochester (10/02/24)
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  • Pharmacist - REMOTE

    Adecco US, Inc. (Woonsocket, RI)
    …and Medicare guidance and timelines. + Ensure accuracy of case setup and clinical review of Medicare appeals cases. + Review internal notes or fax ... As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related...ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach… more
    Adecco US, Inc. (11/01/24)
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  • Revenue Cycle Coordinator IV - Remote/Hybrid…

    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 ... final resolution and adjudication, including refund of credits + Review and advise supervisor or manager on trends of...of reports: + 2 nd insurance level report + Medicare and Medicaid credit balance report + Over $10,000… more
    University of Rochester (10/16/24)
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  • Inpatient Coding & Clinical Documentation…

    Minnesota Visiting Nurse Agency (Minneapolis, MN)
    …proper coding procedures are adhered to as defined by CMS regulations, Local Medicare Carrier Review Policies (LMRP), Local Carrier Determinations (LCD), the AMA ... service needs of the organization as follows: * Interview, hire, orient, review and discipline employees. * Conduct employee performance evaluations and reviews,… more
    Minnesota Visiting Nurse Agency (10/05/24)
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  • Senior Corporate Counsel

    ChenMed (Miami, FL)
    …confidentiality issues + Review medical malpractice claims and share advice + Review Medicare Marketing guidelines to counsel Marketing team + Provides legal ... ensure company compliance with applicable laws and regulations. Corporate Counsel will review policies and practices, lead the legal training of company personnel,… more
    ChenMed (10/17/24)
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