- KPH Healthcare Services, Inc. (Hoffman Estates, IL)
- **Overview** **Scope of Responsibilities:** The Intake Specialist is an experienced individual who is able to assist and manage the referral intake process. **Job ... any changes that possibly may occur within the Insurance Payor, Medicare, or Medicaid + Responsible for completing all mandatory and regulatory training programs +… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... local and national coverage determinations + Comprehensive knowledge of Medicare, Medicaid , and Managed Care requirements + Comprehensive knowledge of community… more
- Centene Corporation (Tucson, AZ)
- …flexibility. **REMOTE ROLE: Must reside in Arizona** Non clinical quality improvement specialist role will evaluate data provided in Excel format and write technical ... reports. State Contract, Medicaid knowledge preferred. **Position Purpose:** Support the development and...forms of incentives. Benefits may be subject to program eligibility . Centene is an equal opportunity employer that is… more
- Novant Health (Salisbury, NC)
- …Health Surgical Institute is seeking a Board Certified/Board Eligible ENT & Allergy specialist to join Novant Health Pinnacle Ear, Nose, Throat & Allergy, a busy ... community benefit (including financial assistance and unpaid cost of Medicare and Medicaid ). In 2022, Novant Health community engagement contributed more than $1.9… more
- TEKsystems (Dallas, TX)
- …enrollment and re-enrollment applications for healthcare providers to Medicare, Medicaid , and commercial insurance plans. Maintain accurate and up-to-date provider ... enrollment, credentialing, or healthcare administration. Strong understanding of Medicare, Medicaid , and commercial insurance enrollment processes. Excellent organizational, communication,… more
- Molina Healthcare (Fort Worth, TX)
- …+ Health claims processing background, including coordination of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims ... and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution… more
- Molina Healthcare (Oshkosh, WI)
- …sales and marketing of Molina Medicare products to dual eligible, Medicare- Medicaid recipients within approved market areas to achieve stated revenue, profitability, ... the product choices available to them, the enrollment process ( eligibility requirements, Medicare review/approval of their enrollment application, timing of… more
- YAI (Manhattan, NY)
- …matters, which may include identifying and assisting with resolutions to eligibility issues and coordinating with external parties if/as needed, checking ... eligibility in applicable electronic systems, preparing and distributing reports...and entitlements in the healthcare and/or I/DD field including Medicaid , Medicare and applicable regulatory agencies. + Strong written… more
- TEKsystems (Jefferson City, MO)
- …ensure compliance and quality. + Complete insurance verification to confirm eligibility , coverage, co-insurance, and deductibles. + Collaborate across teams to ... strong technical aptitude to learn new systems. + Familiarity with Medicare, Medicaid , and commercial health plan guidelines preferred. + Adaptability in a rapidly… more
- Molina Healthcare (Houston, TX)
- …systems and designated state systems, and reports results to accordingly. * Ensures Medicaid and waiver eligibility has been requested and received from state ... reassessments and transition assessments. * Interfaces with state agency that determines eligibility for LTSS, to process and obtain approval of waiver services. *… more