- Molina Healthcare (UT)
- …and contractual guidelines. + Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. + ... improvement. **Skills & Competencies** + Proven experience handling provider disputes, appeals , and overpayment recoveries in a managed care or payer environment.… more
- City and County of San Francisco (San Francisco, CA)
- …interprets and implements billing rules, regulations and provider updates related to Medicare and Medi-Cal via review of released materials. Attends payer and vendor ... healthcare service reimbursements or medical claims from Medi-Cal (Medicaid), Medicare , insurance, third party payors, and individual payors in...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… 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 ... security personnel.) + CBI & FBI fingerprint check, Colorado Court Database check, Medicare Fraud Database, TRAILS Database check. + Possess and maintain a valid US… 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 ... check includes: + CBI & FBI fingerprint check, Colorado Court Database check, Medicare Fraud Database, TRAILS Database check. + This position will also provide… 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 ... security personnel.) + CBI & FBI fingerprint check, Colorado Court Database check, Medicare Fraud Database, TRAILS Database check. + This position will also provide… 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 ... security personnel.) + CBI & FBI fingerprint check, Colorado Court Database check, Medicare Fraud Database, TRAILS Database check. + This position will also provide… 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 ... results. Maintains the Status Change Database. Performs retrospective clinical reviews/ appeals as part of denial process. The UR Specialist...be cross trained to work for the Commercial Resource Analyst when the need arises. Act as liaison to… more
- City and County of San Francisco (San Francisco, CA)
- …meet all of the following criteria: + Be eligible to participate in Medicare , Medicaid, and/or other federal healthcare programs + Possess a National Provider ... + Possess a valid third-party billable provider certification (such as Medicare , Medi-Cal, and/or private insurance) OR have submitted a completed billable… more
- State of Colorado (Grand Junction, CO)
- …name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure ... of state service experience. Minimum Qualification Screening Process A Human Resources Analyst will review the work experience/job duties sections of the online job… more