- Guidehouse (San Marcos, CA)
- …from home._** **Essential Job Functions** + Hospital Claims + Account Review + Appeals & Denials + Medicare /Medicaid + Insurance Follow-up + Customer Service ... Be Nice To Have** **:** + 1+ year's medical provider experience working with UB04, appeals & denials. + Hospital or EOB claims emphasis + PC skills in a Windows… more
- Humana (Atlanta, GA)
- …teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to ... include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. The… more
- UPMC (Pittsburgh, PA)
- Purpose: Reporting to the CMO of Government Products, the AVP, Medicare Medical Services serves as one of the strategic and tactical leaders who works with providers ... contract and CMS requirements for the Government products, with a focus on Medicare , including Special Needs Products for UPMC Health Plans. The AVP works closely… more
- Insight Global (Sarasota, FL)
- …Global is seeking a candidate that can manage billing collection for Medicare account receivables, aiming to minimize outstanding accounts and maximize cash flow. ... Resolves RTP and denied claims, and maintains the electronic Medicare billing system. Coordinates and updates CM and DDE...of a UB 04 form Experience with denials and appeals Knowledge of ICD-9, ICD-10, and CPT codes Experience… more
- MVP Health Care (Tarrytown, NY)
- …achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare ** to join #TeamMVP. If you have a passion for patient-centered advocacy, ... 2 years of experience in utilization management of sub-acute Medicare reviews + Experience with Medicare guidelines...and UM platforms. + Familiarity with CMS regulations and appeals processes. + Ability to work independently and manage… more
- CVS Health (Sacramento, CA)
- …areas. Knowledge of Aetna clinical and coding policy and experience with appeals , claim review, reimbursement issues, and coding is preferable, but a willingness ... and predetermination of covered benefits in the Commercial and Medicare environment with a focus Medicare policy.,...Commercial and Medicare environment with a focus Medicare policy., This Medical Director provides subject matter expertise… more
- BrightSpring Health Services (Bowling Green, KY)
- …issues. Refer all unresolved issues to the next level including grievance and appeals . + Actively market plan to new senior care partners within plan Service ... approved sales and marketing presentations in accordance with applicable Centers for Medicare & Medicaid Services (CMS) and State guidelines and standards. + Conduct… more
- Commonwealth Care Alliance (Boston, MA)
- …accurate, compliant, and timely reimbursements within the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims ... Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare , and commercial payment methodologies and supports audit, compliance, and provider… more
- Houston Methodist (Katy, TX)
- …to: medical coding, insurance billing, collections, patient account resolution, appeals /denials, customer service, cash applications, revenue integrity, etc. This ... to ensure operational billing compliance with government/regulatory agencies and the Medicare and Medicaid programs. + Ensures optimization of timely cash… more
- US Tech Solutions (May, OK)
- …Benefits Manager (PBM) **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