- 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
- Sharp HealthCare (San Diego, CA)
- …by providing guidance on fundraising, completion of Medicare /Medicaid/disability applicants, indigent funding, etc.Perform post-transplant billing counseling ... with clinical team to communicate changes in pre-authorization, denial, medical review, appeals , managed care contracts, and referrals to ensure timely process of… more
- Houston Methodist (Houston, TX)
- …internal and external financial and governmental reporting requirements. Requirements include Medicare cost reports, Federal Tax Returns Health and Human Services ... (HHS)/Centers for Medicare and Medicaid Services (CMS) reporting, Federal and State...by the fiscal inter-mediatry. Also directs re-opening requests and appeals . + Directs the coordination, review and filing of… more
- State of Colorado (Rio Grande County, CO)
- …cash, and donation accounts + Overseeing/completing regular billings for Medicare , Medicaid, Hospice, the Department of Veterans Affairs, Managed Care/Insurance ... name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure… more
- State of Colorado (Denver, CO)
- …Momentum referrals, obtaining identification, securing a payee, applying for Medicaid/ Medicare , and submitting referrals to potential discharge locations. + Must ... CBI & FBI fingerprint check, Colorado Court Database check, Medicare Fraud Database, TRAILS Database check. + This position...if your application is eliminated. You will find the appeals process, the official appeal form, and how to… more
- J&J Family of Companies (Portland, ME)
- …be assigned. Educate HCPs on product coverage, prior authorizations and appeals , reimbursement processes, claims submissions, procedures, and coding requirements of ... access and affordability solutions across multiple payer types and plans (ie, Medicare , Medicaid Managed Care, Commercial). + Execute business in accordance with the… more
- Stony Brook University (East Setauket, NY)
- …business functions including but not limited to: billing, claims analysis appeals , follow-up, financial assistance and customer service. **Duties of a Revenue ... on rejected or denied claims, improper payments and coding issues. + Process appeals . + Liaise with third party billing and collection agencies. + Identify issues… more
- State of Colorado (Pueblo, CO)
- …on Hospital Accreditation Standards, Environment of Care Manual, Centers for Medicare and Medicaid Services, Safety Data Sheets, Colorado State Personnel Procedure ... CBI & FBI fingerprint check, Colorado Court Database check, Medicare Fraud Database, TRAILS Database check. + This position...if your application is eliminated. You will find the appeals process, the official appeal form, and how to… more
- CVS Health (Des Moines, IA)
- …concurrent and prior authorization reviews with peer to peer coverage of denials. * Appeals - The medical director will perform appeals in their "base plan" ... Two (2) + years of experience in managed care ( Medicare and/or Medicaid) MD or DO; Board certification in...we have an Integrated plan. Experience with managed care ( Medicare and Medicaid) utilization review preferred. **Education** MD (Doctor… more
- J&J Family of Companies (Milwaukee, WI)
- …assigned. + Educate HCPs on product coverage, prior authorizations and appeals , reimbursement processes, claims submissions, procedures, and coding requirements of ... access and affordability solutions across multiple payer types and plans (ie, Medicare , Medicaid Managed Care, Commercial). + Execute business in accordance with the… more