- 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)
- …part of our caring community and help us put health first** The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst will be an integral part of the ... of the team as it expands to accommodate the increased responsibilities. The Provider Hospital Reimbursement Analyst r will be primarily responsible… more
- Humana (Frankfort, KY)
- …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
- Humana (Frankfort, KY)
- …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 (Frankfort, KY)
- …Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital , and/or other provider contracts and agreements for the ... State of Mississippi. The Senior Provider Contracting Professional work assignments involve moderately complex to complex issues where the analysis of situations or… 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 (Louisville, 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
- Humana (Frankfort, KY)
- …coding auditor to review inpatient hospital claims for proper reimbursement , handle provider disputes in a result-oriented and metrics-driven environment. ... Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims… more
- Molina Healthcare (Louisville, 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 (Louisville, 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 (Louisville, 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
- 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