- CVS Health (Austin, TX)
- …Qualifications** + Pharmacist + 7-10 years work experience in healthcare + Medicare and/or Medicare -Medicaid Integrated Product Experience + Experience with Part ... D Coverage Determination, Appeals and Grievances and/or Formulary Administration regulatory requirements and audit management + Experience with Part C & D reporting… more
- Adecco US, Inc. (Richmond, VA)
- …deadlines** . + File pleadings in **state and federal courts** , the **Court of Appeals ** , and the **Virginia Supreme Court** . + Manage and audit **liens** (ERISA, ... Medicare , Medicaid, and Workers' Compensation). + Maintain and update.... + Strong understanding of **liens** associated with ERISA, Medicare , Medicaid, and Workers' Compensation. + Proficiency with **case… more
- Molina Healthcare (Green Bay, WI)
- …to healthcare premium. * Assist in resolution for escalated premium issues with Appeals and Grievances team members. * Guide and collaborates with enrollment team to ... timely and accurate processing of payment received.* Marketplace, Commercial, or Medicare healthcare experience with premium billing and reconciliation. * Must have… more
- Evolent (Jackson, MS)
- …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 a major disciplinary or… more
- LA Care Health Plan (Los Angeles, CA)
- …and Outreach, Ansafone, Web Inquiries, MRU (Member Relations Unit), and Appeals and Grievance, performance against key performance indicators and recognizes trends ... daily error reports, analyze results from Call Center, MRP, Medicare , MRU, Outbound and Outreach, and LA Care Covered...or Quality Assurance. Knowledge of and experience of Medi-Cal, Medicare , and Covered California. Skills Required: Good oral and… more
- Molina Healthcare (UT)
- …treatment * Provides second level BH clinical reviews, BH peer reviews and appeals * Supports BH committees for quality compliance. * Implements clinical practice ... State (TX) Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider… more
- City and County of San Francisco (San Francisco, CA)
- …meet all of the following criteria: + Be eligible to participate in Medicare , Medicaid, and/or other federal healthcare programs + Possess a National Provider ... Possess a valid third-party billable provider certification (such as Medicare , Medi-Cal, and/or private insurance) OR have submitted a...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- US Tech Solutions (May, OK)
- …for clinical information. **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
- Highmark Health (Denver, CO)
- …through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as a resource for technical staff. + ... offerings and rules/regulations across multiple states. They must also be familiar with Medicare drug benefit design offerings that may differ by state, while being… more
- Merck (Jefferson City, MO)
- …of patient enrollment process, payer coverage policies, prior authorization process, appeals process, patient support programs, and Hub operations to Field Access ... or reimbursement support * Strong knowledge of health insurance structures ( Medicare Part B, Medicaid, commercial) and related access processes, including benefit… more