- Molina Healthcare (Columbus, OH)
- …State regulations, NCQA guidelines, and CMS standards. + Provides coordination and processing of pharmacy prior authorization requests and/or appeals . + Explains ... member and providers with initiating oral and written coverage determinations and appeals . + Records calls accurately in call tracking system. + Maintains specific… more
- US Tech Solutions (May, OK)
- …volume where needed. **Responsibilities:** Utilizing multiple software systems to complete Medicare appeals case reviews Meeting or exceeding government mandated ... include but not limited to: outbound calls, reviewing and processing Prior Auth's received via fax and ePA, monitoring...clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided… more
- Elevance Health (FL)
- …and personalized support throughout the consumer's treatment journey._ **Authorization Representative II** **Location:** This position will work a hybrid model ... or days may be required based on operational needs. **The Authorization Representative II** is responsible for the administration of prior authorizations requests… more
- Granville Health System (Oxford, NC)
- …to servicing outstanding patient accounts and possible overpayments.# Responsible for processing patient and insurance credit balances timely for resolution.# and ... processing refunds according to the Hospital policy.# Reviews insurance...policy.# Reviews insurance overpayments for accuracy and determines if appeals are needed.# Files bankruptcy claims and appropriately adjusts… more
- Granville Medical Center (Oxford, NC)
- …to servicing outstanding patient accounts and possible overpayments. Responsible for processing patient and insurance credit balances timely for resolution. and ... processing refunds according to the Hospital policy. Reviews insurance...policy. Reviews insurance overpayments for accuracy and determines if appeals are needed. Files bankruptcy claims and appropriately adjusts… more
- UNC Health Care (Smithfield, NC)
- …teamwork and reflects UNC Health Care's mission and philosophy. Responsibilities: 1. Appeals & Managed Care Escalations: Project Manage all 3rd party appeals ... Cosmetic & Elective account agreements to ensure accurate postings and processing by carriers. Troubleshoots self-pay payment issues including credit card… more
- Peachtree Orthopedics (Atlanta, GA)
- …8:00am - 5:00pm Job Type: Full-time Your Impactful Role As a Patient Account Representative , you will play a crucial role in our healthcare team, managing accounts ... receivables, resolving past-due accounts, and ensuring efficient claims processing . Join us to make a meaningful impact in healthcare and advance your career. +… more
- Highmark Health (Columbus, OH)
- …(URAC), Pennsylvania Department of Health, Department of Labor, the Center for Medicare and Medicaid Services (CMS) and state specific regulations. * Efficient ... timely receipt, review and assignment of all incoming physician reviewer referrals and appeals to ensure that NCQA, URAC, CMS, DOH, DOL and state specific regulatory… more
- Priority Health Care (Marrero, LA)
- …activities. This also involves ensuring timely response from third-party payors, processing payor denials, documentation requests, and appeals , and monitoring ... Specialist I can be organized and clarified into distinct categories: Claims Processing and Revenue Generation: + Collect outstanding claims. + Run pre-billing… more
- University of Rochester (Rochester, NY)
- …to obtain maximum revenue collection. Researches, corrects, resubmits claims, submits appeals , and takes timely and routine action to resolve unpaid claims. ... Excel, Access, Email, Emdeon (Fidelis Medicaid Managed Care and Medicare Part B) clearinghouse software, third party claims systems...on the appropriate payer system or contact an insurance representative to obtain information as to why claims are… more
- Elevance Health (Denver, CO)
- …and personalized support throughout the consumer's treatment journey._ **Authorization Representative I** **Location:** This position is on site converting to ... or days may be required based on operational needs. The **Authorization Representative I** is responsible for the administration of prior authorizations requests for… more
- State of Colorado (Denver, CO)
- …or knowledge of the action: Colorado State Personnel Board/State Personnel Director, Attn: Appeals Processing , 1525 Sherman Street, 4th Floor, Denver, CO 80203. ... and guidelines as set forth in the Centers for Medicare and Medicaid Services (CMS) and State regulations, Principles...be in place + Must be proficient in word processing and able to use current communication technology to… more
- City of Alpharetta, Georgia (Alpharetta, GA)
- …The list of essential functions, as outlined herein, is intended to be representative of the tasks performed within this classification. The omission of a function ... stop work orders, etc. + Testifies in court or at Board of Zoning Appeals on code violations. + Takes, investigates, and finds solutions for Department of… more
- State of Colorado (Denver, CO)
- …protected health information and other duties as assigned. Job Duties: Patient Info Processing : This position will engage in daily review of various reports such as ... check including CBI name check, ICON Colorado court database, Medicare fraud database, Reference checks, Professional License verification (licensure requirements),… more
- State of Colorado (Lakewood, CO)
- …or knowledge of the action: Colorado State Personnel Board/State Personnel Director, Attn: Appeals Processing , 1525 Sherman Street, 4th Floor, Denver, CO 80203. ... in the case of healthcare facilities, CMS (Centers for Medicare and Medicaid) mandated requirements. To accomplish this purpose,...Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel… more
- Lancaster General Health (Lancaster, PA)
- …and on-call coverage provided by the LGHP Hospitalists at LRH, serving as representative of the LGHP Hospitalists practice. The Associate director will report to ... formulary chairing Pharmacy and Therapeutics committee + Act as a representative and goodwill ambassador for LRH to patients, families, practitioners, and… more
- LA Care Health Plan (Los Angeles, CA)
- …Oversee overtime work and will produce accurate accounting of each representative work performance. Conducting evaluations of and implementing enhancements to the ... Procedure Coding System (HCPCs) codes. Technical Support to UM Specialist: Processing of time sensitive authorization and pre-certification requests to meet… more
- State of Colorado (Denver, CO)
- …annual business plan by evaluating the requirements of the Center for Medicare and Medicaid Services' (CMS) Mission and Priority document, the Medicaid memorandum ... be in place. + Must be proficient in word processing and able to use current communication technology to...the official appeal form signed by you or your representative . This form must be completed and delivered to… more
- NJM Insurance (Trenton, NJ)
- …+ Bill negotiation. + Provide concise and clear instructions for bill processing . For those procedures requiring audit reports, cite relevant resources, when ... appropriate. + Conduct ongoing review and/or audit of bills as needed for appeals , demands for arbitration, and suit. Provide concise and clear audit reports,… more
- e CancerCare (Nashville, TN)
- …Recognizing their importance and relationship to patient care. Consults with appeals department for disputed medical necessity denied claims. Works and Understands ... and resources to support account resolution activities. Ensures that all processing and reporting deadlines are consistently achieved. Adhere to all standard… more