- Cedars-Sinai (CA)
- …rules and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. This position is responsible for maintaining routine auditing ... including leading all aspects of the review for performance management and accurate coding . + Develops and supervise compliance with corrective action plans as a… more
- Houston Methodist (Houston, TX)
- …with Clinical Research Billing Compliance. + Provides oversight and performs detailed claims analysis and medical record review as necessary, including the ... clinical trial protocols, study budgets, coverage analyses, etc. - Performs detailed claims testing and medical review. - Reviews Medicare Coverage Analysis… more
- Covenant Health Inc. (Knoxville, TN)
- …that require extra care, and we're ready to help you make the best healthcare decisions from conception through delivery. For more than 25 years, we've provided ... delivered over 26,000 high-risk babies at Fort Sanders Regional Medical Center. We offer a range of care services...ICD-9 and CPT codes are used in accordance with coding and reimbursement guidelines. + Ensures that charges for… more
- AssistRx (Orlando, FL)
- …coverage provided for a specific pharmaceutical product. You will support the healthcare providers addressing questions regarding coding and billing and ... This role works directly with healthcare providers & insurance plans/payers to gather information...+ Other skills required: + Previous work experience in Medical Reimbursement or Customer Service. + Submitting billing data… more
- CareFirst (Baltimore, MD)
- …requirements (eg, CMS, state mandates, accreditation standards). + In-depth understanding of medical coding systems (CPT, ICD-10, HCPCS) and the annual code ... Utilization Management (UM) operations, Clinical Product Configuration, Health Plan Claims /Authorization workflows, or related healthcare consulting. **Knowledge,… more
- CareFirst (Baltimore, MD)
- …Skills and Abilities (KSAs)** + Working knowledge of provider billing and coding mechanisms, including special pricing, medical terminology, CPT coding ... procedures, including experience with providers, training, customer service, and claims processing. **Preferred Qualifications:** + Bachelor's Degree in business, … more
- Independent Health (Buffalo, NY)
- …Clinical Reviewer will be responsible for the collection and review of medical records specific to quality complaints/grievances and appeals as indicated in support ... and lead coordination of clinical review with appropriate internal stakeholders and Medical Director. This position will prepare written responses to appeals and… more
- Veterans Affairs, Veterans Health Administration (Butler, PA)
- …or replacement; takes necessary actions to resolve issues. -Reviews medical /administrative files; interviews Veterans to determine eligibility requirements; inspects ... the National Centers for Medicare/Medicaid Service (CMS) Health Care Procedural Coding System (HCPCS). -Ensures surgical implants are Federal Drug Administration… more
- OhioHealth (Columbus, OH)
- …medical information systems, medical claims payment process, medical terminology and coding , case management practices, managed care, and governmental ... Health Management is a strategic leadership role focused on transforming healthcare for communities that OhioHealth serves by overseeing population health… more
- AssistRx (Orlando, FL)
- …pharmaceutical product. The Bilingual Patient Access Specialist will support the healthcare providers addressing questions regarding coding and billing and ... a team that is at the forefront of revolutionizing healthcare by improving patient access to essential medications. +...access + Document and initiate prior authorization process and claims appeals + Report any reimbursement trends or delays… more