- HCA Healthcare (Nashville, TN)
- …coverage. + Provide crucial support to the regulatory compliance team in managing appeals and improving documentation to meet regulatory standards. + Serve as a ... from the centralized peer-to-peer team and others regarding denials and appeals processes, observation level of care, decisions about admission, patient transitions,… more
- Stanford Health Care (Palo Alto, CA)
- …and regulatory reports to government agencies, including but not limited to: * Medicare and Medi-Cal cost reports *Financial disclosures to the Department of Health ... timely and accurate filing of annual government cost reports, including Medicare , Medi-Cal, and HCAI submissions. + Maintain comprehensive knowledge of federal… more
- Cedars-Sinai (CA)
- …applicable rules and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. This position is responsible for maintaining routine ... DHCS. Duties and Responsibilities: + Ensures all services provided to Commercial, Medicare and Medi-cal managed care members are in compliance with program… more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- …and recommended reimbursement rates to administrators; + Attends and participates in appeals hearings for purpose of performing continuous evaluation of cost trends ... complex financial statements; + May attend and participate in appeals hearings; + May act as a liaison with...capita cost for patients in state institutions; + Prepares Medicare cost reports or reviews and approves such cost… more
- University of Southern California (Alhambra, CA)
- …and electronic claims; process tracers, denial and related correspondence; initiate appeals ; compose and submit appeal letters specific challengeable denial issues ... Collections Follow-up and collect on accounts for all payors, including Medicare , Medi-Cal, commercial, guarantor, and other contracted payors. Primary follow-up… more
- Molina Healthcare (Tampa, FL)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more
- Integra Partners (Troy, MI)
- …CMS, health plan policies). + Review and process clinical and administrative appeals ; coordinate with Medical Director when required. + Generate and review ... environment. + Strong understanding of utilization review, authorizations, and appeals processes. + Excellent verbal/written communication and organizational skills.… more
- State of Colorado (Pueblo, CO)
- …and communicate to the applicable WM critical issues, legal matters, potential lawsuits/ appeals , and complaints. + Research the appropriate action or person to ... CBI & FBI fingerprint check, Colorado Court Database check, Medicare Fraud Database, TRAILS Database check. + Possess and...if your application is eliminated. You will find the appeals process, the official appeal form, and how to… more
- CVS Health (Tallahassee, FL)
- …oversight of DSNP/MMP complex populations (Dual-Eligible Special Needs Plan / Medicare -Medicaid Plan) * Develop and lead clinical strategy and objectives for ... UM and participate in UM front line work and appeals in markets as needed. * Confer directly with...focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review, and provider … more
- University of Southern California (Alhambra, CA)
- …specific to ICD-10-CM, ICD-10-PCS, CPT/HCPCS, DRGs, APCs, and Modifiers-from Medicare , Medi-Cal, MAC, RAC, and commercial insurance companies -when there ... appeal. Performs all 1st and 2nd level coding-related denial appeals . All tasks & duties to be perform in...of a particular claim or group of claims. Prepares appeals and rebuttals letters/packages in responses to payer's reason… more