- Whidbey General Hospital (Oak Harbor, WA)
- …pertinent information in notes. + Obtains patient signatures on messages from Medicare and Tricare. + Maintains insurance notebook on different payer requirements. + ... and audits. + Inputs statistically numbers in online reports. + Prepares insurance appeals and follows up as required. + Processes technical denials. + Maintains the… more
- Centene Corporation (Helena, MT)
- …guidelines established by the American Medical Association and the Centers for Medicare and Medicaid Services. + Analyze provider billing practices by utilizing code ... medical records to ensure billing is consistent with medical record for appeals , adjustments and miscellaneous/unlisted code review + Review cases with Medical… more
- City and County of San Francisco (San Francisco, CA)
- …by using ICD-10-CM, ICD-10-PCS, and CPT as required by the Center for MediCare and MediCaid Services, American Medical Association, State of California, the Joint ... The terms of this announcement may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department of Human Resources, 1 S… more
- Medtronic (CA)
- …modifiers, and documentation requirements. + Support customers in navigating Medicare , Medicaid, and commercial payer coverage policies and prior-authorization ... + Provide one-on-one and group training on prior authorization, claim submission, appeals , and payment processes. + Identify, triage, and resolve access barriers in… more
- Cedars-Sinai (Beverly Hills, CA)
- …Investigates, processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate policy. + Begins ... management in the acute inpatient or outpatient settings preferred; knowledge of HMO and Medicare rules in inpatient, home health and at the SNF settings preferred +… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …of the Physician Psychologist Review Unit + Adhere to NCQA, URAC, Medicare and other regulatory standards Education/Relevant Experience: + MD degree with board ... credentialed provider + Active clinical practice in order to participate in panel appeals + Experience in Utilization Management in a managed-care environment (as a… more
- St. Luke's University Health Network (Bethlehem, PA)
- …+ Responsible for coordinating all Network activities associated with RAC requests, appeals , etc. + Processes all requests for patient information from Medicare ... /Medicaid regarding the RAC's in accordance with established hospital and department policies and procedures, HIPAA and State Laws regarding release of information. + Maintains computerized release of information RAC system that logs all activities in the… more
- MyFlorida (Largo, FL)
- …receivables functions to maintain the billing. + Process monthly billing for all Medicare A&B, Medicaid, Medicaid Managed Care, Third Party Insurers, and any other ... needed. + File all inquiries including but not limited to reconsiderations, appeals , patient liability amounts, eligibility, and clerical re-openings. + Monitor all… more
- BrightSpring Health Services (Englewood, CO)
- …goals for cash collections, credit balances, medical records, correspondence, appeals /disputes, accounts receivable over 90 days, and other departmental goals ... management with a working knowledge of Managed Care, Commercial, Government, Medicare , and Medicaid reimbursement + Working knowledge of automated billing systems;… more
- Molina Healthcare (Owensboro, KY)
- …* Provides second level behavioral health clinical reviews, peer reviews and appeals . * Supports behavioral health committees for quality compliance. * Implements ... compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). * Assists with the recruitment and orientation… more