- Medical Mutual of Ohio (OH)
- … Medicare Supplement, and individual plans. Under limited supervision, the Medicare Nurse Reviewer applies medical necessity guidelines in making ... for applicants that have a strong clinical utilization management background. Medicare experience is a plus. **Responsibilities** + Evaluates clinical information… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas ... healthcare? Bring your true colors to blue. The Physician Reviewer is responsible for evaluating clinical service requests made...by the Associate Medical Director of the Physician Psychologist Review Unit + Adhere to NCQA, URAC, Medicare… more
- Centers Plan for Healthy Living (Margate, FL)
- UM Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #664 Tuesday, November 5, 2024 Centers Plan for Healthy Living's goal is to create the ultimate ... for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help identify and manage… more
- Prime Therapeutics (Columbus, OH)
- …and drives every decision we make. **Job Posting Title** Physician Clinical Reviewer - GI- REMOTE **Job Description Summary** Key member of the utilization management ... team, and provides timely medical review of service requests that do not initially meet...clinical determinations cannot be made by the Initial Clinical Reviewer . + Discusses determinations with requesting physicians or ordering… more
- Kepro (AL)
- …for health solutions in the public sector. Acentra is seeking a Physical Therapist Reviewer PRN to join our growing team. **MUST RESIDE IN THE STATE OF ALABAMA** ... Job Summary: The Physical Therapist Reviewer PRN is responsible for evaluating medical records against...assurance standards established by the organization. Job Responsibilities: + Review and interpret patient records and compare against criteria… more
- Chenega Corporation (NM)
- …Services** ' company, is looking for a fully remote **Clinical Quality Reviewer ** to ensure compliance with the contract, and program requirements for Clinical ... national, TRICARE, and URAC standards for consistency. Supports activities of peer review and quality and safety committees. Our company offers employees the… more
- MetroHealth (Cleveland, OH)
- …of additional comorbid conditions. Conducts concurrent and retrospective medical record review on defined patient populations to identify opportunities to improve ... minimum of 3 years of CDI experience or; - CDI Second Level Reviewer with a strong understanding of disease processes, clinical indications and treatments, provider… more
- Granville Health System (Oxford, NC)
- …for Medicaid or other account needs to correct patient outstanding balances Review all Medicare and Medicaid overpayments creating credit balances and ... accounts as they are processed by insurance.# Logs all Medicare crossover bad debts on the appropriate logs.# Works...Medicaid on the appropriate bad debt logs for processing Review and process returned mail by searching for updated… 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
- 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
- Medical Mutual of Ohio (Brooklyn, OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Implements and manages ... the implementation and daily operation of the Medicare Advantage Compliance Program and all compliance-related activities for the Company's Medicare Advantage… more
- AdventHealth (Altamonte Springs, FL)
- …and responding to audit findings in a timely and efficient manner . Update, review , and maintain supporting documentation for the Medicare and Medicaid Uniform ... of work papers for the filing of the annual Medicare , Medicaid, and Champus/Tricare cost reports, audit preparation and...of third party balances of Adventist Health System . Review the reasonableness of hospital interim reimbursement rates and… more
- Robert Half Accountemps (Sacramento, CA)
- …adhere to regulatory standards. Responsibilities: * Analyze and process data entries associated with Medicare billing * Review and submit claims to Medicare ... offering a contract to hire employment opportunity for a Medicare Biller in Sacramento, California. The role is within... coverage and resolve any billing issues * Regularly review and update patient records to ensure accurate information… 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
- USAA (Tampa, FL)
- …currently seeking a dedicated **Business Process Owner Senior** that will support Medicare Supplement Claims for USAA Life Company Claims Operations. This employee ... the Life Company Chief Claims & Fraud Officer and will work on Medicare Supplement Claims activities and ensure a flawless execution of business-related processes,… more
- Walworth County (Elkhorn, WI)
- Medicare Specialist (HHS) Print (https://www.governmentjobs.com/careers/walworthco/jobs/newprint/3201106) Apply Medicare Specialist (HHS) Salary $18.70 Hourly ... Equal Opportunity Employer Position Summary This position is responsible for assisting Medicare beneficiaries with enrollment issues regarding Medicare Part D, … more
- Humana (Leesburg, FL)
- …exceed $113K depending on experience and location. Are you passionate about the Medicare population, looking for an opportunity to work in sales, and wanting the ... through service, organizations, activities and volunteerism + Experience selling Medicare products + Bilingual with the ability to speak,...and therefore subject to driver license validation and MVR review . + Any Humana associate who speaks with a… more
- 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
- 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
- Centene Corporation (Raleigh, NC)
- … materials and sales compliance. Participates in the ongoing oversight, analysis, review , and approval of all beneficiary-facing Medicare materials. In addition, ... , summarization and dissemination of key regulatory updates and changes with the Medicare Marketing Guidelines and relevance on material review . + Provides… more