- Select Medical (Harrisburg, PA)
- …Lead Conversion Call with Business Development team each morning. + Verify Medicare benefits and secondary/supplemental insurance plans of all referred patients as ... the hospital financially viable. + Communicate relevant data to clinical liaisons, case managers, prior authorization team, and physicians to help prepare for… more
- Geisinger (Danville, PA)
- …and reviews the Care Team to determine if enrolled in outpatient Case Management. + Releases Electronic Medical Record and coordinates services. + Provides ... schedules treatment days and times. + Delivers Important Message from Medicare notice and Medicare Outpatient Observation Notice (MOON); completes… more
- Humana (Harrisburg, PA)
- …with the Enterprise Operations Enablement (EOE) team our Insurance AI Lean Business Case for Correspondence Modernization + Development of a process to make use of ... to properly analyze and investigate requirements to determine other liable parties due to Medicare set aside settlement arrangements for both Part C and Part D +… more
- Gentiva (Pittsburgh, PA)
- …administrative workflows such as documentation of referrals, DME pickups, Medicare eligibility, insurance verifications, and patient benefit tracking * Coordinate ... care coordination * Strong understanding of hospice principles, industry regulations ( Medicare , Medicaid, JCAHO, ACHC), and best practices * Familiarity with managed… more
- St. George Tanaq Corporation (Harrisburg, PA)
- …can be based anywhere in the United States. **Responsibilities** + Reviews medical records/ case file, writes a decision that is clear, concise, and impartial and ... **Required Experience and Skills** + One (1) year of Medicare appeals, medical review, clinical, healthcare regulatory interpretation/application, healthcare… more
- Penn Medicine (Lancaster, PA)
- …+ Consults with Pathologists and Histotechnologists for problem solving and appropriate case management. + Provides accurate and timely documentation for all areas ... + A health care provider in good standing with Medicare , Medicaid, and other federal and state health insurance...health insurance programs, ie not excluded from participation in Medicare , Medicaid or any other federal or state health… more
- Evolent (Harrisburg, PA)
- …interventional cardiology to help ensure the delivery of high-value, evidence-based case reviews. Enjoy improved work-life balance while contributing to better ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Guthrie (Sayre, PA)
- …all operational aspects for Care Coordination including, but not limited to Case Management, Utilization Review (UR), Utilization Management (UM), and Medical Social ... five (5) years. Knowledge and ability to demonstrate understanding of Medicare /Medicaid regulations, Medicare Advantage UM rules/regulations, and Commercial… more
- Kestra Medical Technologies, Inc (Scranton, PA)
- …employed by this company unless they are directly involved with the patient's case . COMPETENCIES + Passion: Contagious excitement about the company - sense of ... Food and Drug + Administration and under contract with Medicare . Kestra maintains a drug free workplace and testing...Federal Food and Drug Administration and under contract with Medicare . Kestra maintains a drug free workplace and testing… more
- Banner Health (PA)
- …knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group (APR-DRG) and Ambulatory Payment ... National Correct Coding Initiative (NCCI) and the effect on Case Mix Index by use of specialized software. 7....contacts. Must consistently demonstrate the ability to understand the Medicare Prospective Payment System, and the clinical coding data… more