- Marshfield Clinic (Marshfield, WI)
- …diagnosis codes, Healthcare Common Procedure Coding System (HCPCS), and Center for Medicaid and Medicare Services (CMS) documentation and billing policies. The ... responsible for auditing medical record documentation to determine appropriate coding/ billing for services provided, taking into account American Medical Association… more
- Cardinal Health (Madison, WI)
- …and manages compliance audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services. This ... documentation and coding related to physician or hospital (inpatient and outpatient) billing and/or medical necessity reviews. + Prepares written reports of audit… more
- Molina Healthcare (Racine, WI)
- …according to the SIU's standards. Position must have thorough knowledge of Medicaid /Medicare/Marketplace health coverage audit policies and be able to apply them in ... providers and recipients. The position will review claims data, medical records, and billing data from all types of healthcare providers that bill Medicaid… more
- Humana (Madison, WI)
- …Principal coordinates, implements, and manages oversight of the company's Medicare/ Medicaid Stars Program for aligned areas. The Stars Improvement Principal ... Operations encompasses critical functions including care coordination, quality measurement, billing , claims processing, and customer service, each essential to… more
- J&J Family of Companies (Milwaukee, WI)
- …and affordability solutions across multiple payer types and plans (ie, Medicare, Medicaid Managed Care, Commercial). + Execute business in accordance with the ... both pharmacy and medical/buy & bill benefits (as applicable), coding, and billing . + Reimbursement or relevant managed care experience (revenue cycle, buy-and-bill,… more
- Molina Healthcare (Racine, WI)
- …accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). M-F from 8am - 4:30pm EST will require to work 1 ... coordination of benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of… more
- Molina Healthcare (Kenosha, WI)
- …accordance with the standards and requirements of Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Responsible for the comprehensive ... coordination of benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of… more
- Molina Healthcare (Milwaukee, WI)
- …with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Manages team responsible for the ... Anesthesia, high-dollar complicated claims, COB and DRG/RCC pricing). * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of… more
- CVS Health (Madison, WI)
- …state, federal and company requirements are met and recognize any concerning billing patterns or trends. Activities include: - Conduct a comprehensive medical record ... review to ensure billing is consistent with medical record. - Provide detailed...- Must be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state… more
- Humana (Madison, WI)
- …investigations of reported, alleged or suspected fraud involving Florida's Medicaid Program. The Fraud and Waste Professional 2 coordinates investigation ... Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Understands department,… more