- Evolent (Helena, MT)
- …of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting physicians ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Evolent (Helena, MT)
- …of the request and provides clinical rationale for standard and expedited appeals . . Utilizes medical/clinical review guidelines and parameters to assure consistency ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . . No history of disciplinary or legal action… more
- Evolent (Helena, MT)
- …subject matter expert. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …to insurance companies in a timely manner. + Perform follow-up with Medicare , Medicaid, Medicaid, Managed Care, and Commercial insurance companies on unpaid ... vendor's queries to clarify and to complete the claim filing process. + Process appeals online or via paper submission. + Assist with billing audits and/or related… more
- Elevance Health (Indianapolis, IN)
- …Pharmacy Care Center (CPCC) is a clinical pharmacy call center that services Medicare , Medicaid, and the Commercial member populations. The members we reach out to ... authorization requests from physicians' offices and ensures compliance with Medicare requirements; informs relevant parties of all prior authorization… more
- Huron Consulting Group (Chicago, IL)
- …secondary diagnoses, principal procedure and secondary procedures. Assigns appropriate Medicare Severity Diagnosis Related Groups (MS-DRG), All Patient Refined DRGs ... ICD-CM Official Coding Guidelines for Coding and Reporting, Centers for Medicare /Medicaid Services (CMS) ICD-PCS Official Guidelines for Coding and Reporting o… more
- Adecco US, Inc. (Kansas City, MO)
- …fast-paced role that demands a strong understanding of medical reimbursement, Medicare and commercial payers, and buy-and-bill or specialty pharmacy distribution ... Support (20%)** - Assist offices with claims, billing and coding, appeals , medical benefit interpretation, and co-pay or patient assistance programs. Coordinate… more
- University of Southern California (Arcadia, CA)
- …effective verbal and written communication skills. + Able to compose coding appeals based on documentation, coding guidelines and Coding Clinic for coding denials ... and/or adjustments. + Extensive knowledge of Medicare Part A and how the regulatory requirements impact DRG assignments. + Minimum of three years' experience in… more
- Molina Healthcare (Los Angeles, CA)
- …ensure compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all ... important to be successful in this role. Experience with Appeals , Auditing, and Compliance /Quality will be a good...* Assists in preparation of documents for Centers for Medicare and Medicaid Services (CMS), state Medicaid, National Committee… more
- Robert Half Finance & Accounting (Carlisle, PA)
- …efficiency. Responsibilities: * Oversee the revenue cycle processes for Medicaid, Medicare , managed care, commercial payers, and sliding fee programs. * Establish ... implement performance improvements. * Handle payer contracts, denial management, and appeals to ensure accurate and timely resolutions. * Collaborate with… more