- Baystate Health (Springfield, MA)
- …Regulatory Knowledge: A solid understanding of healthcare regulations, compliance, and reimbursement methodologies, such as Medicare, Medicaid , and commercial ... by defining the financial impact for payment structures and reimbursement methodologies during the negotiation process will be a...rules 2) Will be responsible for hospital Medicare and Medicaid cost report filings, audits, and settlements 3) Will… more
- St. John's Embrace Living (Rochester, NY)
- …patient health care information, billing, and revenue collections + New York State Medicaid and Medicare rules and regulations + Basic methods and procedures of ... privately. + Prepares and submits billing claims for Private, Medicare, Medicaid and other third-party insurances + Maintain Clearinghouse and/or Electronic Medical… more
- State of Indiana (Indianapolis, IN)
- …across Indiana. About the Family & Social Services Administration: The Office of Medicaid Policy and Planning (OMPP) is a division within the Family and Social ... the Director of Quality Improvement (QI), an integral component in serving Medicaid members. This clinical leader will develop, design, implement, and manage… more
- Humana (Lansing, MI)
- …Research and Resolution Lead and is responsible for tracking and trending Michigan Medicaid claims data and completing root cause analyses of claims denials or ... Responsiilities** + Routinely track provider claims data for providers in the Michigan Medicaid network to identify trends in denials and rework. + Analyze claims… more
- Molina Healthcare (Las Cruces, NM)
- …with other department management and leads. This position is primarily in the Medicaid space, however, will cross over to Marketplace and Medicare. This role will ... In addition, works collaboratively with other key departments to increase Medicaid assignment percentages for Molina. + Responsible for day-to-day operations and… more
- Humana (Oklahoma City, OK)
- …management for network providers in Humana's Healthy Horizons in Oklahoma's Medicaid Plan, including provider onboarding, training, education, responding to provider ... as well as appropriate education about participation in Humana's Oklahoma Medicaid plan + Convene Joint Operating Committee meetings with providers, including… more
- Molina Healthcare (Provo, UT)
- …Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits, ... understanding of healthcare regulations, managed care claims workflows, and provider reimbursement models to shape recommendations and action plans. + Translates… more
- Molina Healthcare (San Diego, CA)
- …goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits & ... understanding of healthcare regulations, managed care claims workflows, and provider reimbursement models to shape recommendations and action plans. + Translates… more
- Ventura County (Ventura, CA)
- …is responsible for billing and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare, and general insurance ... reimbursement requirements. IDEAL CANDIDATE The ideal candidate has specialized...Experienced in leading and training staff on Managed Care, Medicaid , Medi-Cal, Medicare, and Commercial Insurance, they ensure accuracy,… more
- PruittHealth (Atlanta, GA)
- …14. Knowledge of advanced directives. 15. Knowledge and understanding of Medicare, Medicaid , Private Pay and Third Party reimbursement . **MINIMUM EDUCATION ... REQUIRED:** Should possess, as a minimum, a high school diploma or its equivalent. Requires minimum two (2) years college education with courses in recreation, education, social work, other behavioral sciences or clinical services. **MINIMUM EXPERIENCE… more