- Guidehouse (El Segundo, CA)
- …from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare / Medicaid + Insurance Follow-up + Customer Service + Billing + UB-04 & ... You Will Do** **:** The **Insurance Patient Account Representative** **(Hospital Claims )** is an extension of a client's business office staff. Representatives… more
- Prime Healthcare (Redding, CA)
- …family. For more information, visit www.shastaregional.com. Responsibilities The Senior Medicare - Medicaid Biller/Collector is responsible for both billing and ... the specific payer guidelines, policies, procedures, and compliance regulations for Medicare - Medicaid . This includes maintaining the deficiency lists used to… more
- BlueCross BlueShield of North Carolina (NC)
- **Job Description** The Manager, Medicare Claims , oversees end-to-end claims services for provider segments, meeting business goals. This role sets ... will result in improved customer satisfaction. + Serve as Medicare Claims Subject Matter Expert and single...in related field. **Bonus Points** + 1-2 years of Medicare and Medicaid experience or a highly… more
- Humana (Columbia, SC)
- …The Senior Business Intelligence Engineer will develop and maintain expertise in Medicaid reimbursement methodologies rooted in complex grouping concepts (EAPG, ... Business Intelligence Engineer will be responsible for: Researching state-specific Medicaid reimbursement methodologies for hospitals and facilities Developing… more
- Humana (Boise, ID)
- …Senior Business Intelligence Engineer will develop and maintain expertise in complex Medicare reimbursement methodologies. This role is within the Integrated ... on Pricer edit resolution + Provide consultation to internal business partners on Medicare reimbursement /editing logic and Humana system logic **Use your skills… more
- Highmark Health (Buffalo, NY)
- …interpret data in government value-based reimbursement reports in the areas of Medicare STARS, Medicaid HEDIS and risk revenue and develop strategic plans to ... of primary care providers (PCP) enrolled in government value-based reimbursement programs and continuous improvement models. This job is...is a highly skilled subject matter expert (SME) in Medicare STARS, Medicaid HEDIS and risk revenue… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Medicaid Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and integrity of ... coordination of analytical processes, investigation and interpretation of Maryland Medicaid risk score methodology, risk score calculation, submissions, enrollment,… more
- Hartford HealthCare (Farmington, CT)
- …timely and accurate collection of third-party payers, resolving outstanding insurance claims across all Hartford HealthCare hospitals, medical group and homecare. ... Provides input on decisions that affect workflows effecting timely resolution of insurance claims . 4. Provides support for other ad hoc analyses and projects as… more
- Centene Corporation (Tallahassee, FL)
- …projects required. 3+ years management experience required. Regulatory knowledge of Medicare , Medicaid , and/or Marketplace required; experience with multiple ... in supporting, managing, and leading strategic projects and initiatives for the Claims functional business unit. This role supports leadership in executing business… more
- Dignity Health (Bakersfield, CA)
- **Job Summary and Responsibilities** The Claims Recovery Manager is responsible for leading the recovery operations within the MSO Claims department. This role ... or GED + Minimum 5 years of progressive experience in healthcare claims recovery, payment integrity, or post-payment audit functions, preferably within a multi-plan… more
- Waystar (Louisville, KY)
- …1K+ hospitals and health systems, and is connected to over 5K commercial and Medicaid / Medicare payers. We are deeply committed to living out our organizational ... of hospital & professional coding and billing workflows and the provider reimbursement process, obtained either through direct experience in a healthcare setting or… more
- Abbott (Austin, TX)
- …and appeal processes and other related matters requiring a specialized knowledge of Medicare , Medicaid and Private Payer reimbursement procedures and ... ** is responsible for implementing and managing clinical trial reimbursement processes to secure Medicare and private...On** + Review clinical investigative plan and payer policies ( Medicare , Medicare Advantage, Medicaid and… more
- CareFirst (Baltimore, MD)
- …such as auditing of contracts, responses to RFI/RFPs, researching Medicare , Medicaid and other industry policies and reimbursement methodologies. Compile fee ... maty be responsible for preparing analyses associated with the development of reimbursement policy, strategies, cost of care impacts and work flows for healthcare… more
- J&J Family of Companies (Fresno, CA)
- …approval processes and business acumen. + Understanding of Medicare , Medicaid , and private payer initiatives affecting reimbursement of pharmaceutical and ... + Educate HCPs on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and coding requirements of… more
- J&J Family of Companies (Stamford, CT)
- …approval processes and business acumen.** **Understanding of Medicare , Medicaid , and private payer initiatives affecting reimbursement of pharmaceutical ... **Educate HCPs on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and coding requirements… more
- J&J Family of Companies (St. Louis, MO)
- …approval processes and business acumen + Understanding of Medicare , Medicaid , and private payer initiatives affecting reimbursement of pharmaceutical and ... include the following. Other duties may be assigned. + Educate HCPs on reimbursement processes, claims submissions, procedures, and coding requirements of payer… more
- J&J Family of Companies (Manchester, NH)
- …approval processes and business acumen. . Understanding of Medicare , Medicaid , and private payer initiatives affecting reimbursement of pharmaceutical and ... . Educate HCPs on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and coding requirements of… more
- Ventura County (Ventura, CA)
- …for billing and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare , and general insurance ... Experienced in leading and training staff on Managed Care, Medicaid , Medi-Cal, Medicare , and Commercial Insurance, they...with billing and processing claims for timely reimbursement and compliance with Medi-Cal, Medicare , and… more
- Danaher Corporation (Cincinnati, OH)
- …and reimbursement landscape. + Communicate regional and local coverage and reimbursement issues for Medicare , Medicaid and Commercial payers through ... and reimbursement . + Support customers with approved resources for denied claims , payer coverage expansion and inadequate reimbursement . + Respond to and… more
- Regeneron Pharmaceuticals (Seattle, WA)
- …and submissions in range of payer environments. Well versed with implementing and executing Medicare , Medicaid , and other payer initiatives. + We expect you to ... **Field Reimbursement Manager (FRM), Ophthalmology - Seattle (PNW)** The...you:** + Previous experience working with billing and medical claims personnel in various health care settings, including, but… more