- J&J Family of Companies (Santa Clara, 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
- Covenant Health Inc. (Knoxville, TN)
- …Demonstrates knowledge and comprehension of State and Federal regulations, Medicare , TennCare, and other Third-Party Payor requirements, assuring departmental ... Health Information Management (HIM), coding, claims management/insurance follow-up or appeals , etc.). Will consider combination of formal education and experience.… more
- Cardinal Health (Sacramento, CA)
- …the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes ... regulations, or third party policy. + Updates patient files for insurance information, Medicare status, and other changes as necessary or required. + Keeps email… more
- CVS Health (Springfield, IL)
- …functional areas such as Claims, Provider Services, IT, Grievance & Appeals , Member Services, and Medical Management (Quality, Network, Compliance, Health Equity, ... reflects a proven track record of government programs such as Medicaid, Medicare , or Dual Eligible including government affairs, legal, and an in-depth compliance… more
- Cardinal Health (Sacramento, CA)
- …may need to happen to not delay patient care. + Complete any pre-service appeals to obtain paying approval based on medical necessity. + Communicate effectively with ... organizational skills. + Understanding of managed care contracts and fee schedules, including Medicare and Medicaid. **_What is expected of you and others at this… more
- Cleveland Clinic (Beachwood, OH)
- …thorough benefits investigation and processes any necessary prior authorizations and/or appeals for pharmacy claims. + Explain benefit coverage and financial ... the patients. + Resolve aspects of specialty pharmacy insurances, including Medicare , Medicaid, Pharmacy Benefit Managers (PBM), and Preferred Provider Organizations… more
- Calvary Hospital (Bronx, NY)
- …to facilitate reimbursement for services provided by the Hospital. Oversees the appeals process for those cases for which reimbursement has been denied. Conducts ... interface with the Finance Office regarding pertinent insurance information, eg Medicare , Medicaid, Blue Cross, and Commercial Insurance. Performs other related… more
- Centene Corporation (Raleigh, NC)
- …healthcare coverage, providing access to affordable, high-quality services to Medicaid and Medicare members, as well as to individuals and families served by the ... medical and pharmacy consultants for reviewing complex cases and medical necessity appeals . Participates in provider network development and new market expansion as… more
- University of Southern California (Arcadia, CA)
- …cost per case, excess days, resource utilization, readmission rates, denials, and appeals . + Collaborates and communicates with multidisciplinary team in all phases ... continuous improvement in both areas. + Perform 100% UR Review on all Medicare One-Day admissions. + Proactively identifies and resolves delays and obstacles to… more
- University of Rochester (Rochester, NY)
- …follow-up to obtain maximum revenue collection. Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims. ... and all audits. + Coordinates response and resolution to Medicaid and Medicare credit balances. + Requests insurance adjustments or retractions. + Reviews and… more