- Emanate Health (Covina, CA)
- …codes submitted for Medicare and Covered CA lines of business. Coding specialist will be responsible to review medical records and claims data to ensure external ... system in the United States, and the #19 ranked company in the country. **J** **ob Summary** Responsible for...Program and STAR measures coding related functions. The coding specialist will work with the IPA Director, Health Plan,… more
- Commonwealth Care Alliance (Boston, MA)
- …appropriateness, efficiency and quality of the services provided. The LTSS Program Specialist will have a wide range of responsibilities including project management ... and (e)assistance to these external partners as necessary. The Specialist is expected to work with managers and staff...and databases that CCA implements. - Working knowledge of Medicare and Medicaid (MassHealth) - Familiarity with and full… more
- Stony Brook University (East Setauket, NY)
- Senior Revenue Cycle Specialist **Position Summary:** At Stony Brook Medicine, the **Senior Revenue Cycle Specialist ** will act as an operational leader in the ... prevention initiatives. + Liaises with Managed Care Contracting and Insurance Company Provider Representatives to resolve underpayments and denials. + Collaborates… more
- Organon & Co. (Plymouth Meeting, PA)
- **Job Description** **The Position** The Contract Operations Sr. Specialist - US Market Access Contract Operations is responsible for overseeing the execution of ... complex Purchase-Based agreements that support the company 's pharmaceutical sales and market access strategies. This role partners closely with Sales, Pricing,… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …to join the **Senior Care Outreach and Retention** team\! As a Pharmacy Specialist , you'll be the frontline of our Senior Care Team, guiding members through ... Teams, Excel, and Word\. + Basic understanding of medications evaluated under Medicare 's Star Ratings system, which measures quality and effectiveness for members\.… more
- Katmai (Usaf Academy, CO)
- …as needed at the local treatment facilities. + Assists TRICARE eligible and Medicare -eligible patients in accessing local TRICARE and Medicare providers in ... the Central Referral Center. + Maintains current directories of local Medicare providers, suppliers, and Institutions. + Evaluates case management process utilizing… more
- One Medical (San Francisco, CA)
- …Medical Flex Health Navigator supporting our Senior patients (age 65+) on Medicare , you are focused on delivering exceptional care coordination and team assistance. ... on: Manage comprehensive care coordination for senior patients, including specialist referrals, appointment scheduling, and follow-up with high-risk or disengaged… more
- Cordis (Trenton, NJ)
- …the people behind the people who keep saving lives.** The **Clinical Closure Sales Specialist ** is focused on the support of the Cordis closure business within a ... Completes training and manages product complaints appropriately + Maintain company standards involving ethical and moral character while professionally representing… more
- Lyric (Newtown Square, PA)
- Lyric is an AI-first, platform-based healthcare technology company , committed to simplifying the business of care by preventing inaccurate payments and reducing ... or American Health Information Management Association (AHIMA) Certified Coding Specialist -Physician (CCS-P) + Working knowledge of pre-payment editing and payment… more
- Commonwealth Care Alliance (Boston, MA)
- …provider community. In this highly visible field position, the provider relations specialist acts as the primary liaison between CCA and its providers including ... + Experience in health plan provider relations. **Experience (Desired)** + Medicare /Medicaid experience preferred. + Experience with CPT coding and authorization… more
- Commonwealth Care Alliance (Boston, MA)
- …Engagement & Performance **Position Summary:** The Senior Provider Relations Specialist is responsible for building, maintaining and strengthening relationships with ... expert of the team + Managed Care experience (preferably Medicare /Medicaid) + Experience in health plan provider relations +...compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in… more
- Robert Half Office Team (Kansas City, MO)
- Description We are looking for a dedicated Licensed Medicare Specialist to join an insurance company in Kansas City, Missouri. This is a long-term contract ... skills, an entrepreneurial mindset, and a deep understanding of Medicare products and compliance standards. Could turn into a...before seeking assistance. + Maintain compliance with CMS and company guidelines in all sales activities. + Track and… more
- Commonwealth Care Alliance (Boston, MA)
- …This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for ... as necessary on all new and revised coding logic, related Medicare /Medicaid policies for review/approval through the Payment Integrity governance process.… more
- Cedars-Sinai (CA)
- **Job Description** The Managed Care Compliance Specialist is responsible for assisting with the implementation of the internal auditing and monitoring program ... and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. This position is responsible for...as the need arises. + Educates CSHS employees on company policies and procedures regarding access to care, the… 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. **Provides expertise to ... field. + 5 years of experience as a Sourcing Specialist or equivalent experience. **Professional Certification(s)** + Certified Purchasing...and Compensation: + Employee bonus program. + 401(k) with company match up to 4% and an additional … more
- Sumitomo Pharma (Kansas City, KS)
- Sumitomo Pharma Co., Ltd., is a global pharmaceutical company based in Japan with operations in the US (Sumitomo Pharma America, Inc.), focused on addressing patient ... dynamic, highly motivated individual for the position of **Multi-Specialty Portfolio Specialist /Associate Portfolio Specialist .** This position is being posted… more
- Aveanna Healthcare (Houston, TX)
- …$17.00 per hour Position Details Position: Operations Specialist (Medical Records Specialist ) Join a Company That Puts People First! Aveanna Healthcare is ... Operations Specialist / Administrative Assistant ApplyRefer a FriendBack Job...Wellbeing Top 100 Companies of 2024 + Named Best Company for Work-Life Balance, Happiest Employees, Best Culture, and… more
- Robert Half Accountemps (Philadelphia, PA)
- Description We are looking for a motivated and detail-oriented Medical Accounts Receivable Specialist to join our team, working Monday through Friday from 8:00 AM to ... part in maintaining the financial health of our organization by handling Medicare billing, patient accounts, and insurance claims with precision and efficiency.… more
- Penn Medicine (Plainsboro, NJ)
- …Are you living your life's work? **Looking for a FT Verification Specialist ** **Schedule: M-F Day** **Department: Multi Specialty** **Location: 5 Plainsboro Rd** ... provide insurance verification and coordination for all commercial, Medicaid and Medicare cases across programs to facilitate patient access to clinical services… more
- US Tech Solutions (RI)
- **Job Title: Prior Authorization Specialist ** **Location: Fully remote** **Duration: 12 months contract** **Job Description:** + Prior Authorization Specialist ... requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. + Must apply information provided through multiple… more
