- 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
- Providence (Beaverton, OR)
- …them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care coordination, case management and ... Utilization Management Experience (EX. Concurrent Review, Prior Authorization, Medical Audits, Appeals or Delegation) + Experience working in a health plan, medical… more
- Centene Corporation (Jefferson City, MO)
- …optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and ... medical necessity appeals . + Assists in the development and implementation of physician education with respect to clinical issues and policies. + Identifies… more
- CaroMont Health (Gastonia, NC)
- …medical record for clinical denials. Composes a detailed summary of care and sends appeals to MCO, Medicare , or RAC for reversal of original determination. May ... and appeal results. Maintains the Status Change Database. Performs retrospective clinical reviews/ appeals as part of denial process. The UR Specialist will be cross… more
- KPH Healthcare Services, Inc. (Gouverneur, NY)
- …of the electronic payment application for Medicare + Help complete any Medicare audits, medical records requests, and appeals and monitor the outcomes. + ... **Job Summary:** Assist in billing and cash application of Medicaid/ Medicare /DME/Home Infusion claims. Manage open accounts receivable which requires rebilling… more
- Dignity Health (Bakersfield, CA)
- …knowledge of DHPR and CMS rules for Claim. Submission, Claim Payment, Eligibility, Appeals for Commercial, MediCare and MediCal lines of business. + Bachelor's ... Degree - Bachelor's Degree or equivalent experience. **Where You'll Work** The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization… more
- Intermountain Health (Murray, UT)
- **Job Description:** This position provides expertise in the areas of appeals and grievances for highly regulated insurance plans with unique plan designs, ... commercial employer group, individual and government insurance programs such as Medicare , Medicaid, Affordable Care Act (ACA), Children's Health Insurance Program… more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance with… more
- Stanford Health Care (Palo Alto, CA)
- …the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials. This position requires strong ... analytical and communication skills. The Clinical Government Audit Analyst and Appeals Specialist II will collaborate with clinical staff, coding professionals, and… more