- State of Colorado (Denver, CO)
- …name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure ... of notice or acknowledgement of the department's action. For more information about the appeals process, the official appeal form, and how to deliver it to the State… more
- Athena Health Care Systems (Southbridge, MA)
- …have been edited by interdisciplinary team members. + Tracks and schedules all Medicare certifications and recertification. + Mails and tracks all Medicare ... and faxes medical records to QIO for any requested appeals . + Assists with compiling medical records and preparing...medical records and preparing for submission with subsequent level appeals to QIC, ALJ, etc. Specific Requirements: + Must… more
- Athena Health Care Systems (Middletown, CT)
- …have been edited by interdisciplinary team members. + Tracks and schedules all Medicare certifications and recertification. + Mails and tracks all Medicare ... and faxes medical records to QIO for any requested appeals . + Assists with compiling medical records and preparing...medical records and preparing for submission with subsequent level appeals to QIC, ALJ, etc. Specific Requirements: + Must… more
- Houston Methodist (Houston, TX)
- …requests for information. **SERVICE ESSENTIAL FUNCTIONS** + Prepares and submits the annual Medicare cost report for each HM hospital and assists in cost report ... amendments, audit, appeals and reopening process. + Independently prepares federal and...and keeps up-to-date with government regulations (ie Centers for Medicare and Medicaid (CMS), Internal Revenue Service (IRS), Federal… more
- Catholic Health (Buffalo, NY)
- …is responsible for the coordination, preparation, and timely filing of the various Medicare , Medicaid, Champus cost reports, surveys, rate reviews, filing of rate ... appeals , determination of state and federal budget impacts on...newly identified initiatives. The position coordinates audits related to Medicare (cost report, wage index, etc.) and Medicaid. The… more
- New York State Civil Service (Queens Village, NY)
- …assist in contacting insurance company for preauthorization payments, and/or file appeals on denials of preauthorization. * Participating in the formulation, ... eligibility for full and unconditional participation in the Medicaid and Medicare programs. Failure to maintain certification and Medicaid/ Medicare eligibility… more
- Insight Global (Des Moines, IA)
- …with Senior Living, billing. Specifically, within the skilled nursing space. Understanding Medicare , Medicaid, Medicare part B, managed therapies, managed care ... best practices. * Identify and address issues through denial reviews, appeals , and regulatory research; update training as needed. Support onboarding/disengagement… more
- Marshfield Clinic (Marshfield, WI)
- …Reimbursement Auditor (Remote in Wisconsin) **Cost Center:** 101651059 Coding-Audit Appeals Educ **Scheduled Weekly Hours:** 40 **Employee Type:** Regular **Work ... Common Procedure Coding System (HCPCS), and Center for Medicaid and Medicare Services (CMS) documentation and billing policies. The individual will typically… more
- Humana (Indianapolis, IN)
- …to, an overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy), and reviews for DME, genetic testing, etc. ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical… more
- Whidbey General Hospital (Coupeville, WA)
- …necessity reviews at a minimum of every 12 hours (twice daily). Completes Medicare extended stay reviews, as appropriate. + Identifies and escalates all 1MN and ... 2MN Medicare IP stays. Collaborates with Transitions of Care Management...avoidable days, resource utilization, readmission rates, concurrent denials, and appeals . + Supports the vision, mission, and values of… more