- 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 or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance with… more
- J&J Family of Companies (Fort Worth, TX)
- …eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals /grievances); practice management; Medicare and Medicaid rules and ... regulations; OSHA; HIPAA; and state-specific clinical staff licensing / certification requirements for product compounding, admixture, administration and monitoring. Required Qualifications: + A minimum of a bachelor's degree + A valid driver's license issued… more
- J&J Family of Companies (Phoenix, AZ)
- …eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals /grievances); REMs certification; Medicare and Medicaid rules and ... regulations; and state-specific clinical staff licensing / certification requirements for product administration and monitoring. + Educate staff on payer requirements, coding, billing, claim submission, and acquisition. + Share TC insights with coalition… more
- J&J Family of Companies (Jacksonville, FL)
- …eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals /grievances); REMs certification; Medicare and Medicaid rules and ... regulations; and state-specific clinical staff licensing / certification requirements for product administration and monitoring. + Educate staff on payer requirements, coding, billing, claim submission, and acquisition. + Share TC insights with coalition… more
- Surgery Care Affiliates (Boise, ID)
- …+ Candidate MUST HAVE knowledge of medical billing, payer follow-up, payer contracts, appeals , self-pay billing, Medicare and Medicaid billing, AR posting, along ... with excellent customer service skills. + Experience in a hospital, outpatient surgery center or related field is a MUST; Computer experience, Excel, Word, Medical Billing Software and Applications; Working knowledge of Medical Terminology. USD $18.00/Hr. USD… more
- Advanced Orthopedics and Sports Medicine Institute (Freehold, NJ)
- …including, posting, Accounts Receivable (AR) (Insurance & Patient collection), denial appeals , charge modifications, adjustments, Medicare accounts, etc. Phone ... must be turn on daily and ready to receive all calls related to patient bills, whether from patients or insurance companies Check Navinet, or payors website for payment statues and set a follow-up bean on open balance accounts constantly. Provide a monthly… more
- University of Southern California (Los Angeles, CA)
- …with Medicare and Medicaid reimbursement guidelines including audits and appeals processes. + Req Strong analytical, organizational, and communication skills. + ... focusing on tasks such as preparing and ensuring compliance with the Medicare Cost Report (MCR) and related Medicaid Cost Reports. Additionally, the role… more
- UTMB Health (Galveston, TX)
- …calculations and estimates and ensures UTMB compliance with Medicare and Medicaid regulations. **Scope:** Institutional **Responsibilities:** + Responsible ... for technical aspects, calculations and analyses of multiple areas of Medicare and Medicaid reimbursement components including, but not limited to, cost report… more
- Corewell Health (Grand Rapids, MI)
- …steps of the member appeal and fair hearing processes for all non- Medicare products to thoroughly investigate appeal requests, leveraging critical thinking skills, ... Essential Functions + Responsible for complex and thorough investigation of appeals , external complaints, and fair hearing reviews including: formulate action plan… more
- Cognizant (Annapolis, MD)
- …. Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes. ... Director based on the review of clinical documentation in accordance with Medicare , Medicaid, and third-party guidelines. . Effectively document and log claims/… more