- Humana (Montpelier, VT)
- …adjudication, where appropriate. Monitors/Leads investigations to ensuring appropriateness of billing practices using a variety of investigational tools. Prepares ... + Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of experience with...a group of seasoned professionals. + Proven knowledge in Medicare regulations + Excellent PC skills MS Excel and… more
- CVS Health (Irving, TX)
- …pharmacy along with member dispute resolution for mail order and the Medicare Prescription Payment Program (M3P). **Key Responsibilities** -Lead the team and build ... set forth by government agencies including the Centers for Medicare and Medicaid Services (CMS) This is a hybrid...considered. **Required Qualifications** + 7+ years experience in finance, billing , or a related field + 3+ years experience… more
- WellSense (Boston, MA)
- …health insurance company serving members across Massachusetts and New Hampshire through Medicare , Individual and Family, and Medicaid plans. Founded 25 years ago as ... **Education Preferred** + **Bachelor's degree and/Claims adjudication or medical billing /coding certification preferred** **Experience Required:** . At least 2 years… more
- Diversicare Healthcare Services & Diversicare Ther (Huntsville, AL)
- …entities per company guidelines and State and Federal regulations. 14. Ensures Medicare and Medicaid regulatory guidelines are completed accurately and timely (ie: ... all documents are available and meet the request. 17. Participates in billing reviews (Triple Check) to ensure claims have supporting MDS assessments documents.… more
- BAYADA Home Health Care (Hilo, HI)
- …opportunities: Become our next Client Services Manager in a fast-growing Medicare -certified home health office** + BAYADA offers a comprehensive benefits plan ... + You'll also help maintain effective fiscal management by coordinating the billing and processing of services (entering OASIS documentation) and monitoring metrics… more
- The Wesley Community (Saratoga Springs, NY)
- …by the rehab department while ensuring standards of practice are aligned with Medicare and other reimbursement regulators as it relates to accuracy and timeliness of ... billing and documentation as well as additional supervisory aspects...+ Communicates to nursing, social services and financial department Medicare Part B Utilization + Attends weekly Medicare… more
- Bon Secours Mercy Health (Oberlin, OH)
- …and distributes patient education documents, such as Important Message from Medicare , Important Message from Tricare, Observation Forms, MOON form, Consent forms, ... system to support POS (Point of Service Collections) and billing processes to assist with a clean claim rate....using the Advanced Beneficiary Notice (ABN) software to inform Medicare patients of possible non-payment of test by … more
- Corewell Health (Grand Rapids, MI)
- …Representative for a temporary assignment starting October 5, 2025, supporting both Medicare and Non- Medicare pharmacy customer service operations. This role ... a permanent role after February 28, 2026. Hours of Operation: Medicare Support: + Open Enrollment (Oct 1 - Mar...1 year of relevant experience Pharmacy technician experience, pharmacy billing or claim adjudication Preferred + Associate's Degree +… more
- Somatus (Falls Church, VA)
- …of life concerns for all patients. + Collaborates with Facility Management and Accounting/ Billing to address patient issues related to insurance or copay concerns. + ... + Educate patients on their insurance options including Group Health Plans (GHPs), Medicare , Medicaid, and managed care plans. Serve as a liaison between patients,… more
- UCLA Health (Los Angeles, CA)
- Description The Business Data Analyst plays a key role within the Medicare Advantage Operations team, acting as a liaison between business units, IT teams, and ... other related field required + Minimum of five years' experience in a Medicare or Managed Care environment managing enrollment, claims or encounters required +… more