- Molina Healthcare (Omaha, NE)
- …8am-5pm PST hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing and ... subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and...with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for … more
- CVS Health (Hartford, CT)
- …home) based anywhere in the US. Responsibilities of this Medical Director role are related to Medicare Appeals . * Direct daily work on part C appeals (both ... policy for the enterprise * Provide ongoing education regarding Medicare policy and appeals to the appeal nurses and territory Utilization Management Staff *… more
- Molina Healthcare (St. Petersburg, FL)
- **Job Summary** Responsible for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for ... direct oversight, monitoring and training of provider disputes and appeals to ensure adherence with Medicare standards...disputes and appeals to ensure adherence with Medicare standards and requirements related to member and provider… more
- Molina Healthcare (Des Moines, IA)
- …Summary** Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance ... * Leads, organizes, and directs the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and...of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes that is responsible for reviewing and… more
- CVS Health (Nashville, TN)
- …focus primarily on review appeal cases for denied medical services. This includes First Level Appeals / Second Level Appeals / Expedited Appeals / Appeal ... Hearings / Special Projects and Committee participation when needed. The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. The Medical Director will act as a business and clinical… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …Emory Healthcare in Administrative Law Judge (ALJ) hearings and if required, Medicare Appeals Council. + Primary duties and responsibilities: Participates in ... We're seeking under the direction of the **Utilization Management Appeals Professional, Registered Nurse** is responsible for managing clinical...external reviews such as Medicare Recovery Audit Program or other third-party audit programs… more
- Humana (Frankfort, KY)
- …Director (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing… more
- Humana (Little Rock, AR)
- …Medical Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... established clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be passionate about… more
- Elevance Health (Durham, NC)
- …programs, guidelines, and processes are strongly preferred. + Solid knowledge of Medicare Grievance and Appeals rules and regulations is highly preferred. ... **Manager II Grievance/ Appeals ** **- Claims Support** **Office Locations:** _The selected...regulated audits. + Oversight of the IRE portions of Medicare audits and universe production. + Serves as a… more
- OhioHealth (Columbus, OH)
- …Manager with updates. CGS audits and auditors Working with our legal vendor for Medicare Appeals . Working with OHA and CBSA facilities on wage index ... Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This position… more