- Humana (Harrisburg, PA)
- …and other vendors. + Document all calls and requests. + Search for Medicare and Medicaid Guidelines. + Process all incoming fax/emails request for services the ... and/or ICD-10 codes. + Member service + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization. **Additional… more
- Humana (Harrisburg, PA)
- …medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical ... develop and maintain medical coverage policies utilizing an evidence based medicine review process. **Location:** work at home anywhere Humana is seeking a Senior… more
- Intermountain Health (Harrisburg, PA)
- **Job Description:** Provides assistance to the Reimbursement Manager to control or review the following areas for government and third party payers for assigned ... appropriately recorded, reviewed, and reconciled. Reviews or prepares monthly Medicare and Medicaid contractual allowance calculations using technically acceptable… more
- Robert Half Accountemps (Doylestown, PA)
- …part in maintaining the financial health of our organization by handling Medicare billing, patient accounts, and insurance claims with precision and efficiency. ... to manage accounts through to their final resolution. Responsibilities: Process Medicare billing activities, ensuring accurate handling and management of patient… more
- Humana (Harrisburg, PA)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's… more
- Prime Therapeutics (Harrisburg, PA)
- …qualified entities across all lines of business to support the Centers for Medicare & Medicaid Services (CMS) Star and HEDIS quality measure programs, including but ... meets the specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid...$17.85 - $25.48 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our… more
- Prime Therapeutics (Harrisburg, PA)
- …strategy. This role provides leadership and subject matter expertise on Medicare Stars, Medicaid quality and the Commercial/Health Insurance Marketplace Quality ... goals + Drive the client quality strategy for all lines of business ( Medicare , Medicaid, Commercial/HIM); serve as primary point of contact and subject matter expert… more
- Prime Therapeutics (Harrisburg, PA)
- …lines of business (Employer Markets, Health Insurance Marketplace (HIM), Commercial, Medicare , and Medicaid). This individual is the primary relationship and ... Lead retention efforts for Employer Markets, Health Insurance Marketplace, Commercial, Medicare , and Medicaid health plan clients; drive the adoption and consistent… more
- Intermountain Health (Harrisburg, PA)
- …Integrity (CDI) Registered Nurses (RN) and Intermountain Physician Advisors to review complex facility encounters and assign International Classification of Diseases ... optimization of reviews while patients are hospitalized. It aids in the review of quality measures including Patient Safety Indicators and Hospital Acquired… more
- Redeemer Health Home Care & Hospice (Meadowbrook, PA)
- …ICD-10 and CPT-4 guidelines, UHDDS sequencing guidelines, CMS coding guidelines, Medicare and Medicaid regulations and the American Hospital Association coding ... practitioners. Responsible for consistently meeting quality expectations for documentation review , coding, and meets Redeemer Health's expected productivity standards… more