- Humana (Columbia, SC)
- …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
- Humana (Columbia, SC)
- …of our caring community and help us put health first** The Director, Provider Contracting initiates, negotiates, and executes physician, hospital , and/or other ... Provider Contracting communicates contract terms, payment structures, and reimbursement rates to providers. Analyzes financial impact of contracts and terms.… more
- Humana (Columbia, SC)
- …The Provider Contracting Executive initiates, negotiates, and executes physician, hospital , and/or other provider contracts and agreements. The Provider ... diverse scope and complexity ranging from moderate to substantial. The Provider Contracting Executive communicates contract terms, payment structures, and … more
- Edwards Lifesciences (Columbia, SC)
- …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
- Option Care Health (Columbia, SC)
- **Extraordinary Careers. Endless Possibilities.** **With the nation's largest home infusion provider , there is no limit to the growth of your career.** Option Care ... the largest independent home and alternate site infusion services provider in the United States. With over 8,000 team...and more impactful. Our organization requires extraordinary people to provide extraordinary care, so we are investing in a… more
- Humana (Columbia, SC)
- …- 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 (Columbia, SC)
- …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 (Columbia, SC)
- …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
- Centene Corporation (Columbia, SC)
- …clinical programs to be initiated + Monitor prior authorization requests + Provide clinical support to internal departments and address clinical related questions + ... and implement programs designed to impact DUR for both Medicaid and Medicare + Develop, implement, and maintain policies...MS) in pharmacy. 2+ years of mail order, retail, hospital or managed care pharmacy experience or 1+ years… more
- PruittHealth (Columbia, SC)
- …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 (Columbia, SC)
- …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