- Marshfield Clinic (Marshfield, WI)
- …exciting missions in the world!** **Job Title:** Arrhythmia Nurse Specialist **Cost Center:** 301351038 Mfld-Cardiology **Scheduled Weekly Hours:** 40 **Employee ... been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately… more
- Molina Healthcare (Racine, WI)
- …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 (Kenosha, WI)
- …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 (WI)
- …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 (Green Bay, WI)
- …timely and accurate processing of payment received.* Marketplace, Commercial, or Medicare healthcare experience with premium billing and reconciliation. * Must have ... Billing /R **Required License, Certification, Association** Marketplace, Commercial or Medicare Industry preferred Required Licensure/Certification: None **Preferred Education** Associates… more
- Molina Healthcare (Madison, WI)
- …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 (Milwaukee, WI)
- …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
- Novo Nordisk (Wausau, WI)
- …impact + Demonstrates understanding of the local payer market including Medicare , Commercial and Medicaid benefit designs, Payer Coverage, Prescription Coverage ... Requirements, Step Therapy, Coverage Gap, Copays, and Deductibles and the impact on customer decisions + Demonstrates understanding of territory customer groups and affiliations such as IPAs, Medical Groups, Health Systems, and Local Clinics and uses this to… more
- SSM Health (Madison, WI)
- …and prior authorization for appropriate equipment/supplies. + Ensures compliance with Medicare , Medicaid and Accreditation Standards. + Works in a constant state ... of alertness and safe manner. + Performs other duties as assigned. EDUCATION + High School diploma/GED or 10 years of work experience EXPERIENCE + Two years' experience PHYSICAL REQUIREMENTS + Frequent lifting/carrying and pushing/pulling objects weighing 0-25… more
- SSM Health (Madison, WI)
- …appropriate. + Facilitates compliance with The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS) and state quality and patient safety ... requirements by coordinating, organizing and communicating appropriate information to designated committees, teams, work groups and leadership in a timely fashion. Leads initiatives for high priority opportunities as identified by leadership. + Performs other… more