- Sanford Health (Fargo, ND)
- …prevent disease or disability. Counsels' patients and family members about self- management on prevention and treatment plan for health issues, tailoring instructions ... Keep abreast of regulatory processes and payer systems such as Medicare, Medicaid , managed care, and private sources, as applicable. Demonstrate extensive advanced… more
- Novant Health (Salisbury, NC)
- …required. Previous experience in managed care, infusion care, and case management and previous home health/hospice case management experience; preferred. ... needs in order to appropriately receive referrals. + Knowledge of Medicare/ Medicaid rules/regulations necessary to understand criteria for determining patient … more
- Elevance Health (Norfolk, VA)
- …resolution through direct contact with providers, claims, pricing and medical management department. + Identifies and reports on provider utilization patterns which ... years of customer service experience including 2 years experience as a Network Management Rep; or any combination of education and experience, which would provide an… more
- Aveanna Healthcare (Orange, CA)
- …our dynamic team in Orange, CA. Pay: $22 -$24/HR + Quarterly Incentive Eligibility Benefits Overview: + Health, Dental, Vision Insurance + 401(k) Savings Plan with ... achievement of optimal patient outcomes. Essential Responsibilities Staffing & Scheduling Management + Develop and maintain weekly caregiver schedules that meet… more
- US Tech Solutions (May, OK)
- …criteria and plan design. Includes verifying insurance coverage and eligibility , interpreting clinical guideline criteria, consulting physicians and other healthcare ... patients, and other healthcare professionals following agreed-upon approval & denial management processes. (60%) + Collaborates with the technicians and prior… more
- Virtua Health (Mount Holly, NJ)
- …and complete documentation of individual plan of care in EMR and case management documentation system.* Metrics - Accountable to job specific goals, objectives and ... years experience as Clinical Social Worker. Basic understanding of Medicare, Medicaid and managed care. Discharge planning or home health background.Excellent verbal… more
- Highland Hospital (Rochester, NY)
- …documented for out-of-network payers, refers our self-pay patients to Financial Case Management (FCM) for Medicaid assessment or Financial Assistance, reviews ... include review diagnosis and history for correct insurance coverage, insurance eligibility and coverage verification using the three patient identifiers, confirming… more
- Capgemini (Cincinnati, OH)
- … Medicaid or Exchange program/ product build knowledge (Enrollment, Eligibility , Claims, Provider network, encounters etc) (Highly Recommended having exposure to ... areas to plan testing (good to have) Incorporate effective scope/change management impact assessment and controls Maintain project documentation Escalate issues to… more
- American Heart Association (Dallas, TX)
- …in monitoring relevant national programs such as the Center for Medicare/ Medicaid Services (CMS): Merit-Based Incentive Payment System (MIPS) and, Hospital Inpatient ... information in national programs, databases, and clearinghouses. + Provides project management support and subject matter expertise for the submission of American… more
- Sanford Health (Worthington, MN)
- …selection, dispensing and setup, documentation, billing, compliance, and performance management . Provide first-line communication with a variety of patients, ... documentation, and reimbursement guidelines/issues, including but not limited to Medicare, Medicaid , other third party, and contracted payers. Balance the cash… more