- Adecco US, Inc. (Henderson, NV)
- …with providers to clarify clinical information and explain determinations . Ensure compliance with Medicare Part D, Medicaid, and commercial plan guidelines ... . Collaborate with pharmacy technicians and medical directors on final decisions . Accurately document all cases and manage a high volume of reviews . Support cost-effective, safe, and evidence-based patient care **Requirements** . Bachelor's or Doctorate of… more
- Elevance Health (Miami Gardens, FL)
- …merchandise. + Processes prior authorization requests from physicians' offices and ensures compliance with Medicare requirements. + Informs relevant parties of ... all prior authorization determinations. + Provides resolutions to grievances and appeals issues. **Minimum Requirements:** + Requires HS diploma or equivalent and minimum of 1 year of pharmacy experience; or any combination of education and experience, which… more
- Catholic Health Initiatives (Baudette, MN)
- …other duties as assigned. + The position is responsible for following all compliance of Medicare and HIPAA policies. **Qualifications** High school diploma or ... equivalent Able to perform basic mathematics for payment calculation Intermediate computer skills **Preferred** Healthcare experience Thorough understanding of insurance policies and procedures (will train) Working knowledge of medical terminology **Overview**… more
- Medical Express Ambulance Service (Skokie, IL)
- …submissions. Applicants must have ambulance billing experience, including knowledge of Medicare , Medicaid and MCO compliance , coding, billing, posting, and ... excellent communication and computer skills. A good understanding of medical terminology and commercial insurance guidelines is necessary. Excellent salary and benefits, including sign on bonus, health, dental, life, AFLAC disability insurance, and 401K plan.… more
- TEKsystems (Hammond, IN)
- …records + Collaborate with insurance verifiers to obtain authorizations + Ensure compliance with Medicare medical necessity guidelines + Discuss copayments, ... prepayments, and outstanding balances with empathy and clarity ✅ What We're Looking For: + 1-2 years of radiology scheduling experience + Proficiency in EPIC (required) + Strong attention to detail and ability to multitask under pressure + A warm, empathetic… more
- Elevance Health (Chandler, AZ)
- …programs. + Processes prior authorization requests from physicians offices and ensures compliance with Medicare requirements; informs relevant parties of all ... prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits. + Generates reports relating to rebates, physician… more
- Elevance Health (Seattle, WA)
- …restrictions. Process prior authorization requests from healthcare providers to ensure compliance with Medicare requirements, and inform relevant parties of ... determinations. + **Collaboration** : Work closely with healthcare providers, insurance companies, and pharmacies to resolve complex medication access cases. + **Education and Communication** : Inform members about pharmacy-based rules, alternative… more
- Hawaii Pacific Health (Lihue, HI)
- …work to improve the overall quality of medical record documentation to ensure compliance with Medicare and Medicaid (CMS) guidelines and to expedite ... reimbursement. You will use both clinical and coding knowledge to obtain documentation through extensive interaction with physicians, nursing, other patient caregivers, Case Management and Health Information Management staff. You will also ensure that the… more
- Logan Health (Kalispell, MT)
- …rooms for safety and cleanliness. + Assists the healthcare team in maintaining compliance with Medicare and all applicable regulatory standards. + Maintains ... close surveillance of patient monitor screens for patient deviations as applicable to assigned area(s). Responds to monitor alarms and contacts appropriate stakeholder for patient care as applicable to assigned area(s). + Works with the healthcare team to set… more
- UTMB Health (Galveston, TX)
- …+ Obtains and documents informationrequiredfor third party reimbursement. + Ensures compliance with Medicare andthird-partycoverage. + Communicates with patient, ... referral source, UTMB physician and clinical staffregardingany obstacle to access or authorization. **Salary Range:** Actual salarycommensuratewith experience or range if discussed and approved by the hiring authority. **Equal Employment Opportunity** UTMB… more