- Molina Healthcare (Scottsdale, AZ)
- …surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Specialist , Quality Interventions/ QI Compliance contributes to one or ... Health or Healthcare. **Preferred Experience** 1 year of experience in Medicare and in Medicaid. **Preferred License, Certification, Association** + Certified… more
- Modernizing Medicine (Phoenix, AZ)
- …Chile, and Germany. ModMed (https://www.modmed.com/company/) is hiring a driven Patient Claim Specialist who will play a pivotal role in shaping a positive patient ... medical billing claims submission process and working with insurance carriers required (eg, Medicare , private HMOs, PPOs) + Manage/ field 60+ inbound calls per day +… more
- HonorHealth (AZ)
- …Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of health care services with the ... Responsible for coordinating and conducting medical necessity reviews for all Medicare , AHCCCS, Self-pay, and all other payers, upon admission and concurrently… more
- Mayo Clinic (Phoenix, AZ)
- …Competitive retirement package to secure your future. **Responsibilities** The HME Specialist I position is the first of multiple career opportunities within ... service. Must be able to work independently as needed. Knowledge of Medicare , Medicaid and/or private insurance billed preferred with attention to detail. Physical… more
- Banner Health (Peoria, AZ)
- …that sets us apart from the competition. As a Post Acute Alignment Specialist , you will be optimizing referral development for **Home Health, Home Medical Equipment ... key accounts. Must have strong knowledge of governmental regulations, Medicare eligibility requirements, comprehensive understanding of potential care plan needs… more
- Molina Healthcare (Phoenix, AZ)
- …to determine if providers have sanctions/exclusions. * Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of ... Medicare . * Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found. **JOB QUALIFICATIONS** **Required… more
- Molina Healthcare (Chandler, AZ)
- …in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Enters denials and ... * Customer/provider experience in a managed care organization (Medicaid, Medicare , Marketplace and/or other government-sponsored program), or medical office/hospital… more
- Molina Healthcare (Tucson, AZ)
- …with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research ... benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory… more
- Molina Healthcare (AZ)
- …tools such as Department of Health and Human Services (DSHS) and Medicare billing guidelines, Molina claims processing policies and procedures, and other resources ... to validate overpayments made to providers. * Completes basic validation prior to offset to include, eligibility, coordination of benefits (COB), standard of care (SOC) and diagnosis-related group (DRG) requests. * Enters and updates recovery applications and… more
- Molina Healthcare (AZ)
- …Directory (including ongoing execution, QA and maintenance of supporting tables), Medicare Provider Directory preparation, and FQHC/RHC reports. + Generates other ... provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, Network Access Fee, etc.).; and mailing label extract generation. + Develops and maintains documentation and guidelines for all… more