- Humana (Sacramento, CA)
- …on Pricer edit resolution + Provide consultation to internal business partners on Medicare reimbursement/ editing logic and Humana system logic **Use your skills ... closely with IT, the pricing software vendor, CIS BSS, claims operations, and other business teams involved in the...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
- City and County of San Francisco (San Francisco, CA)
- … claims processing, and/or collecting healthcare service reimbursements or medical claims from Medi-Cal ( Medicaid ), Medicare , insurance, third party ... and tracking of issues; + Performs revenue analysis related to charge errors, claims submission volume, denials and trends based on claim type and/or payer,… more
- Humana (Sacramento, CA)
- …Disputes team reviews and educates providers when there is a dispute on adjudicated claims that contain a code editing related denial or financial recovery. The ... Demonstrate ability to problem-solve complex coding issues + Experience with Medicare and Medicaid coding guidelines + Strong data entry and attention to detail… more
- Humana (Sacramento, CA)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... certification from the AAPC and/or AHIMA) + Extensive knowledge of medical claims processing and familiarity with reimbursement methodologies, ICD, CPT, and HCPCS +… more
- Stanford Health Care (Palo Alto, CA)
- …payer rejections, denials, and performing appeals as necessary + Electronic or hardcopy claims editing and submission to payers + Recognizing potential trends ... and procedures and medical terminology + Knowledge of payer landscape, including Medicare , Medicaid , Workers' Compensation, Managed Care, or other Commercial… more
- Stanford Health Care (Palo Alto, CA)
- …after a detailed review of medical records. Ensure compliance with Medicare , Medicaid , third-party guidelines, Local Coverage Determinations (LCD), National ... while identifying instances of overpayments and underpayments. Proficiency in healthcare claims analysis, including the ability to review, interpret, and evaluate … more