- Hartford HealthCare (Farmington, CT)
- …2. Researches literature from regulatory groups such as; HHS/OIG, Medicare , Medicaid, NGS, etc., professional and peer organizations' practices/policies/guidelines ... of documentation of Evaluation and Management o Experience with interpreting Medicare , Medicaid and third-party billing and compliance regulations necessary. .… more
- Walgreens (Sherman Oaks, CA)
- …billing and submission of claims to government-sponsored health care programs, including Medicare , Medicaid, and all other third-party payers, as well as the ... bodies and contracts with payers and pharmaceutical manufacturers (BOP, DEA, Medicare , accreditation bodies, compounding, FDA, etc.). + Complies with all federal… more
- Trinity Health (Livonia, MI)
- …medical necessity and issues Advanced Beneficiary Notice as appropriate for Medicare primary outpatients. Provides cost estimates. Collects and documents Medicare ... Secondary Payer Questionnaire (MSPQ) and obtains information from the patient if third party payers need to be billed (ie, worker's compensation, motor vehicle accidents and any other applicable payer). Maintains operational knowledge of regulatory… more
- MVP Health Care (Schenectady, NY)
- …You will be responsible for performing analytics and reporting on Medicare , Commercial Exchange, and Medicaid/HARP member populations. + Provideanalytical support on ... to Risk Adjustment programs to improve and optimize program targeting for Medicare and commercial exchange populations. + Use Clinical Risk Group (CRG) software… more
- Fairview Health Services (Hibbing, MN)
- …with regulations. + Conducts face-to-face encounters for recertifications as required by Medicare . + Serves as a liaison between the hospice team, attending ... in inpatient, outpatient, and home-based palliative care. + Knowledge of Medicare /Medicaid hospice regulations. + Experience in a medical director role within… more
- Centene Corporation (Queens, NY)
- …Department of Health (CDOH), Local Department of Social Services and Center for Medicare & Medicaid Services (CMS). The Clinical Quality Assurance RN will also ... of Health (DOH) and Local Department of Social Services and Center for Medicare & Medicaid Services (CMS regulations). Working in a home care environment or… more
- TEKsystems (Morrisville, NC)
- …explain benefits offered by all payer types, including private/commercial and government (ie, Medicare , Medicaid, VA, and DOD), with expertise in Medicare Part B ... + Navigates through payer challenges by asking appropriate questions to obtain the necessary result + Acts as an assigned liaison to client contacts (eg, regional contact for sales representatives) + Maintains records in accordance with applicable standards… more
- Kelsey-Seybold Clinic (Richmond, TX)
- …and is in-network with major insurance plans. KelseyCare Advantage, a Medicare Advantage plan offered to Houston-area beneficiaries and affiliated with ... achieved an overall rating of 5-out-of-5-stars as part of the Centers for Medicare and Medicaid CMS annual assessment for eight consecutive years, including 2024.… more
- BJC HealthCare (Farmington, MO)
- …to detail and maintain knowledge and competence with insurance carriers, Medicare guidelines as well as federal, state, and accreditation agencies. ... must be able to understand, articulate and enforce hospital compliance with Medicare Secondary Payer (MSP), HIPAA Privacy Standards, Patient Bill of Rights and… more
- Texas Health Resources (Fort Worth, TX)
- …aspects of each treatment session in accordance with departmental, JCAHO, Medicare , and other applicable regulatory guidelines. + Documents assessments of education ... patient understanding of education provided in accordance with departmental, JCAHO, Medicare , and other applicable regulatory guidelines. + Reports and documents… more