- Humana (Frankfort, KY)
- …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 (Frankfort, KY)
- …- 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
- Molina Healthcare (KY)
- …subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes * Provides data driven analytics to finance, ... performance is achieving desired results. * Keeps abreast of Medicaid and Medicare reforms and impact on the Molina...* Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment,… more
- CenterWell (Frankfort, KY)
- …experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + ... degree in a related field + Experience with Florida Medicaid + Experience with Physical Therapy, DME, Cardiac or... Experience a plus + Current nursing experience in Hospital , SNF, LTAC, DME or Home Health. + Bilingual… more
- Molina Healthcare (Bowling Green, KY)
- …and/or functional requirements related to but not limited to coverage, reimbursement , and processing functions to support systems solutions development and ... **JOB DUTIES** + Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to… more
- Waystar (Louisville, KY)
- …of hospital & professional coding and billing workflows and the provider reimbursement process, obtained either through direct experience in a healthcare ... Integrity products + Ability to interpret regulatory guidelines from CMS, Tricare, and Medicaid websites + Ability to understand the vocabulary used in hospital … more
- Oracle (Frankfort, KY)
- …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
- Molina Healthcare (KY)
- …modeling current and future contract rate proposals. * Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of ... Business Intelligence tools (Medinsight, PowerBI), and Executive Dashboard. * Generate hospital performance analytics tools on a quarterly basis; develop reports on… more
- Molina Healthcare (Owensboro, KY)
- …modeling current and future contract rate proposals. + Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of ... Business Intelligence tools (Medinsight, PowerBI), and Executive Dashboard. + Generate hospital performance analytics tools on a quarterly basis; develop reports on… more
- Molina Healthcare (Owensboro, KY)
- …(UB04/1500 form). * Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS ... from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions… more
- Pfizer (Frankfort, KY)
- …decision making roles of all levels at integrated health systems, large hospital systems, health insurance plans, state departments of health, county/city health ... programs. This includes a clear understanding of the commercial, Medicaid and Medicare landscape as it relates to the...to educate colleagues across Pfizer on insights gained. * Provide the marketing and strategy teams with key local… more
- Humana (Louisville, KY)
- …the operations of the Company's senior-focused primary care and home care businesses. + Provide guidance and advice with respect to a variety of issues related to ... + Medicare billing, enrollment, and conditions of participation rules + coding/ reimbursement and revenue cycle management + assisting in compliance reviews of… more
- Humana (Frankfort, KY)
- …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
- Ascendis Pharma (KY)
- …interest and capabilities assessment tool for HEOR research concept development. + Provide scientific input and participate on strategic HEOR planning teams and ... US payers, including both commercial and public payers such as Medicare and Medicaid . + Collaborate with commercial and medical in responding to external value… more