- 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
- Elevance Health (Pembroke Pines, FL)
- …authorization requests from physicians offices and ensures compliance with Medicare requirements; informs relevant parties of all prior authorization determinations. ... + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, sales team, and members related to formulary and prescription… more
- Catholic Health Services (West Islip, NY)
- …not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and Patient Access departments to ensure ... required. + Current knowledge of NY Department of Health and Centers of Medicare and Medicaid regulations is required. + Knowledge of Joint Commission Standards, and… 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
- BrightSpring Health Services (Englewood, CO)
- …incoming/outgoing correspondence, medical records , payer/patient refunds, payer audits, appeals , and providing Revenue Cycle Management (RCM) support . The ... a plus + Working knowledge of Managed Care, Commercial, Government, Medicare , and Medicaid reimbursement; knowledge of automated billing systems and experience… more
- US Anesthesia Partners (Austin, TX)
- …companies for status on outstanding claims. + Processes and follows up on appeals to insurance companies. + Refiles claims as needed. + Works correspondence daily. ... of insurance processing, guidelines, laws, and EOBs. + Knowledge of managed care, Medicare , and Medicaid guidelines. + Data entry skills with high accuracy. +… more
- Peak Vista (Colorado Springs, CO)
- …foundational understanding of code sets and relevant use based on payors including Medicare , Medicaid, Commercial, Sliding Scale and Full Fee + Utilize and navigate ... and accurately reported. + Provides expertise to Accounts Receivable Staff in addressing appeals for denials due to potential coding errors. + Support clinic staff… more
- Logan Health (Kalispell, MT)
- …service to stakeholders for questions and concerns. + Responsible for all Medicare , Medicaid, and Case Management insurance denials processing as applicable to ... assigned area(s). + Responsible for all insurance appeals and works with appropriate stakeholders to ensure completion as applicable to assigned area(s). + Serves as… more