- Molina Healthcare (Long Beach, CA)
- …ensure compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all ... in this role. Productivity is important with quick turnaround times. Experience with Appeals , Auditing, and Compliance /Quality will be a good fit for this position.… more
- CVS Health (Madison, WI)
- …areas. Knowledge of Aetna clinical and coding policy and experience with appeals , claim review, reimbursement issues, and coding is preferable, but a willingness ... pre-certification, and predetermination of covered benefits in the commercial, Medicare , and Medicaid environment. This Wheelchair DME consultant provides subject… more
- COOLSOFT (Harrisburg, PA)
- …required. Description : DHS and the HHS DC worked with the Centers for Medicare & Medicaid Services (CMS), and other federal partners responsible for the programs, ... of Long-Term Living (OLTL) * Bureau of Hearings and Appeals (BHA) within the Office of Administration * Office...and Early Learning (OCDEL) * Centers for Medicaid & Medicare Services (CMS) * Administration for Children and Families… more
- Insight Global (Boca Raton, FL)
- …on regulations such as HIPAA, Stark Law, the Anti-Kickback Statute, Medicare /Medicaid, and third-party payor requirements; addressing AI and cybersecurity issues in ... response; and providing guidance on commercial insurance matters, including credentialing, appeals , and contracting. The role also involves drafting, reviewing, and… more
- US Tech Solutions (TX)
- …for this position. **Skills:** + MUST HAVE MANAGED CARE exp and Medicare /Medicaid knowledge. + MUST HAVE 6 months of experienced with Prior Authorization(required). ... + MUST HAVE experience with Medicare Part D + Must Have Pharmacy Benefit Management...have experience in handling calls regarding prior authorization and appeals ? **About US Tech Solutions:** US Tech Solutions is… more
- Abbott (Plano, TX)
- …review department to obtain appropriate authorizations. + Assist with appeals processes as and when necessary. **Required** **Qualifications** + Associates ... + General knowledge of private insurance, Worker's Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review. Some… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and regulatory requirements. * Provide clinical oversight for utilization management, appeals , and complex case reviews. * Participate in internal committees focused ... work in the US Preferred Skills and Experience * Experience with Medicaid, Medicare Advantage, and Commercial insurance products. * Advanced degree (MBA, MPH, MHA)… more
- Humana (Indianapolis, IN)
- …setting + Knowledge of one or more of the following + Medicaid + Medicare + Certification with Six Sigma and/or the Project Management Institute + Grievance and ... Appeals experience and/or knowledge + Data-driven performance/KPI management +...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Buffalo Hearing & Speech Center (Buffalo, NY)
- …billing as assigned individually by the accounts receivable manager. Experience in Medicare and Medicaid HMO's, Commercial payers such as ChampVA, Tricare, UHC, ... up is to be done bi-monthly on assigned controls to include corrected claims, appeals , phone calls, or provider rep assistance to assure any missing or incorrect… more
- Houston Methodist (Houston, TX)
- …FUNCTIONS** + Assists the department in distributing required notices, including the Medicare Notice of Discharge to patients, securing signatures on the form from ... and answering questions regarding the appeal process + Distributes the Medicare Notice of Discharges to identified patients, including capturing patient and… more