- Atlantic Health System (Morristown, NJ)
- …Mandatories, LMS/Corporate Compliance, Unit Based Shared Governance, CEUs, Peer Review , Certification, BSN preferred, Involvement, UBSG, Hand hygiene,). Ensures ... 100 Accountable Care Organizations to Know - Becker's Hospital Review + Best Employers for Workers over 50 -...highest - twelve consecutive times, and the Centers for Medicare and Medicaid Services awarded us again with its… more
- Prime Therapeutics (Trenton, NJ)
- …based upon relevant source data (eg clinical criteria, client criteria, Medicare LCD). Provides support for clinical client inquiries and internal partners. ... + Ability to collaborate and work well as a team. + Data review and interpretation skills required. **Preferred Qualifications** + Managed care experience (Health… more
- Cognizant (Trenton, NJ)
- …team and collaborate with stakeholders and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or HCFA paper or EDI ... UB/institutional (CMS-1450) and/or professional (CMS 1500) claims. + Knowledge of Medicare /Medicaid payment and coverage guidelines and regulations. + Must be able… more
- Atlantic Health System (Morristown, NJ)
- …to resolve the issue or set-up service when appropriate. 4. Assists with review and revision of procedures and documentation related to accreditation, adhering to ... 100 Accountable Care Organizations to Know - Becker's Hospital Review + Best Employers for Workers over 50 -...highest - twelve consecutive times, and the Centers for Medicare and Medicaid Services awarded us again with its… more
- Advanced Orthopedics and Sports Medicine Institute (Freehold, NJ)
- …Receivable (AR) (Insurance & Patient collection), denial appeals, charge modifications, adjustments, Medicare accounts, etc. Phone must be turn on daily and ready to ... and requirements that dictate release of information Perform 30, 60, 90 days review and document all outstanding accounts relating to assigned payor or group. All… more
- Teva Pharmaceuticals (Parsippany, NJ)
- …of National pharmacy and medical benefit payer contracts, including Commercial, Medicare and Managed Medicaid + Assess contract language risks and opportunities ... Create and maintain contract templates, playbooks and clause libraries Review and Negotiation Support: + Work closely with Legal...+ Work closely with Legal and Compliance teams to review terms and address legal risk + Support and/or… more
- Atlantic Health System (Morristown, NJ)
- …patient/family assessment and multidisciplinary collaboration. 2. Ensures daily chart review , utilization reviews, coordination of discharge planning activities and ... 100 Accountable Care Organizations to Know - Becker's Hospital Review + Best Employers for Workers over 50 -...highest - twelve consecutive times, and the Centers for Medicare and Medicaid Services awarded us again with its… more
- Gentiva (Hamilton, NJ)
- …Group (IDG), as assigned, including presiding over IDG, presentation of patients for review , coordination of minutes, review of patient charts to note and ... practice, including industry standards, regulations, and best practices (ie, Medicare , Medicaid, JCAHO, ACHC), company policies/procedures, and understanding ofterminally… more
- RWJBarnabas Health (West Orange, NJ)
- …and regulatory issues relating to payor relationships, third-party administrators, Medicare Advantage, and Medicaid Managed Care. This position requires at ... health system finance Essential Functions: Contract Drafting, Negotiation, and Review + Draft, negotiate, and review a...Negotiation, and Review + Draft, negotiate, and review a broad array of managed care and value-based… more
- Atlantic Health System (Morristown, NJ)
- …assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines and provide ongoing feedback and analysis of ... rejections from recurring. + Meets with the providers to review the audit findings and to recommend ways to...100 Accountable Care Organizations to Know - Becker's Hospital Review + Best Employers for Workers over 50 -… more