- Humana (Raleigh, NC)
- …our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business ... the Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support… more
- Edwards Lifesciences (Raleigh, NC)
- …They will work directly with hospital leaders and physicians to deliver hospital economic analyses customized to each provider . This individual will also ... of reimbursement plans (coding, coverage, payment) unique to each provider . + Articulate a thorough understanding of the structural heart landscape, trends,… more
- TEKsystems (Morrisville, NC)
- …pharmacy and medical benefits (heavier pharmacy focus). Top Skills Reimbursement , insurance verification, prior authorization, benefits verification, provider ... Reimbursement Case Manager - Onsite Training, Remote After...Strong understanding of major payers (private/commercial and government: Medicare, Medicaid , VA, DoD). + Proficiency in insurance verification, prior… more
- Guidehouse (Raleigh, NC)
- …and third party payer accounts that are subject to pre-bill claim edits, hospital billing scrubber bill hold edits, and claim denials. **This position is 100% ... for charge reconciliation audits + Escalate departments noncompliant with policy and provide action plan when needed + Responsible for the daily resolution of… more
- Humana (Raleigh, NC)
- …- 5 years of experience in negotiating managed care contracts with physician, hospital and/or other provider contracts. + Proficiency in analyzing, understanding ... part of our caring community and help us put health first** The Provider Contracting Professional 2 initiates, negotiates, and executes dental provider contracts… more
- Gentiva (Lillington, NC)
- …hospice agency promptly if unable to complete F2F visits as scheduled. + May provide F2F coverage for multiple provider numbers with approval. **About You** ... physicians, interdisciplinary group (IDG) members, patients, caregivers, and families. + Provide clinical recommendations to the IDG based on F2F assessment… more
- Oracle (Raleigh, NC)
- …focus more on patient care by reducing administrative burden of clinical and reimbursement tasks such as charting, documentation, and coding by applying power of ... opportunities to prevent future denials, and ensure maximum appropriate reimbursement . This role is critical for financial recovery and...on experience preparing appeals for claim denials in the hospital and ambulatory setting + 3+ years hands on… more
- PruittHealth (Raleigh, NC)
- …levels of care. 2. Must be knowledgeable of private insurance, Medicare and Medicaid coverage criteria, rules and regulations and reimbursement methodologies. 3. ... continuum and facilitating admissions into the Pruitt Health network. 5. Must provide excellent customer service to all referral sources and network of providers.… more
- Humana (Raleigh, NC)
- …for services rendered is complete, compliant and accurate to support optimal reimbursement . The Nurse Auditor 2 work assignments are varied and frequently require ... in the state they reside. + Minimum of 2 consecutive years acute inpatient hospital care experience in critical, intensive care setting within the last 5 years (Not… more