- Access: Supports For Living (Middletown, NY)
- …of behavioral health billing in New York State, particularly regarding Medicare , Medicaid, Medicaid Managed Care, and Commercial Insurance. Key Responsibilities + ... + Maintain a clear understanding of claims processing, payer denials, and appeals . + Prepare recurring and adjusting journal entries and financial analyses for… more
- University of Rochester (Albany, 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 works… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …days, all causes * Assist with the segmentation of concurrent review offerings into Medicare / Medicaid / Commercial Payors, as needed * Reviews medical records of ... to Hospital leadership * Support and/or perform the ALJ and DAB appeals process; especially ALJ support * Demonstrate experience with multiple EMR/EHR; beneficial… more
- Rush University Medical Center (Chicago, IL)
- …are met. + Flexes schedule to meet department needs. + Assists with managing Medicare Important Message processes + Works with CM and Patient Access to ensure ... designated support for functions including payer approval/certification communication, denial appeals , and/or level of care management processes. In accordance with… more
- CVS Health (Salt Lake City, UT)
- …optimal, cost-effective outcomes. + Telephonic clinical case management with Medicare population. + Uses Motivational Interviewing and engagement interventions to ... + Discharge planning experience + Utilization review, prior authorization, concurrent review, appeals experience + CCM preferred + DSNP experience a plus + Knowledge… more
- Cabinet Peaks Medical Center (Libby, MT)
- …with all CPMC policies and procedures, laws, regulatory requirements, Medicare Conditions of Participation, ect. Develops and maintains department policies ... in coding; reviewing, coordinating, and monitoring the denial management and appeals process in a collaborative environment. Promotes individual professional growth… more
- Humana (Indianapolis, IN)
- …program; and work closely with the Utilization Management (UM) of services and associated appeals related to adults with mental illness and/or SUD + Leads BH policy ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- US Tech Solutions (May, OK)
- …other internal groups regarding determination status and results (seniors, pharmacists, appeals , etc). + Identify and elevate clinical inquiries to the pharmacist ... in PBM on managed care environments **Skills:** + Prior Authorization + Medicare and Medicaid + Call handling experience. **Education:** + Pharmacy Tech license… more
- Commonwealth Care Alliance (Boston, MA)
- …Referral and authorization; Regulatory compliance; Billing and payments; Complaints and appeals ; Policies and procedures. + Identify opportunities for training and ... + Experience in health plan provider relations. **Experience (Desired)** + Medicare /Medicaid experience preferred. + Experience with CPT coding and authorization… more
- Dignity Health (Bakersfield, CA)
- …of Utilization Management in medical review activities, peer-to-peer consultations, appeals and grievances and other related duties. **Job Requirements** **Minimum ... of clinical standards of care, NCQA requirements, CMS guidelines, and Medicaid / Medicare programs and dual eligible populations, and benefit systems is preferred. -… more