- Highmark Health (Pittsburgh, PA)
- …unique processing arrangements including Federal Employee Program (FEP) and Medicare Advantage. **ESSENTIAL RESPONSIBILITIES** + Coordinates the clinical care with ... the patient, family, physician(s), and other members of the interdisciplinary team. + Completes and documents admission, concurrent, and discharge reviews of all inpatients and selected outpatients. + Develops and implements an effective discharge plan while… more
- Banner Health (Worland, WY)
- …and education to staff in order to meet designated accuracy, compliance and productivity goals using available statistical standards. Provides appropriate training ... of managed care contracts, other third-party payors, AHCCCS if applicable, and Medicare , along with knowledge of medical terminology. Requires the ability to make… more
- Saint Francis Health System (Tulsa, OK)
- …with medical field knowledge. Knowledge, Skills and Abilities: Knowledge of Medicare , TJC, federal and state regulations. Demonstrated effective management skills. ... delivery driver and warehouse staff records for accuracy of information and compliance with established procedures. Advises employees on care and preservation of… more
- Munson Healthcare (Manistee, MI)
- …Commission (TJC) EOC, EM and Life Safety standards, The Centers for Medicare and Medicaid Services (CMS) requirements, Michigan Occupational Safety and Health ... safety and environment of care, security and emergency management.Oversees and manages compliance with all applicable regulations including but not limited to TJC,… more
- Covenant Health Inc. (Knoxville, TN)
- …Review, approve/decline, and process refund requests. + Attends all payer meetings concerning Medicare and other payor compliance . + Performs other duties as ... rheumatology, sleep medicine and urology. Position Summary: Demonstrates knowledge of Medicare and payer billing guidelines and policies. Demonstrates ability to… more
- Tufts Medicine (Lowell, MA)
- …reimbursement sources. Escalates to referral management director and/or referral manager , in circumstances of potential admission where reimbursement sources appear ... indicatean appropriate hospice referral. Presents the advantage of the hospice Medicare /Medicaid benefits to referral sources. + Thoroughly understands the … more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Supports corporate and ... lifecycle processes for all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid), including HEDIS audit submission, Consumer Assessment… more
- Humana (Franklin, IN)
- …Healthy Horizons in Indiana is seeking a Care Coordinator 2 (Field Care Manager 2) who assesses and evaluates member's needs and requirements to achieve and/or ... address the member's identified needs + Coordinates with all Medicare payers, Medicare Advantage plans, and ...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Trinity Health (Clive, IA)
- …basics of coding diagnoses and procedures as required for insurance authorizations and Medicare compliance . Utilizes online program for Medicare ... physician offices. Ensures that patients meet financial requirements including Medicare medical necessity, payer pre-certifications and referrals. Provides excellent… more
- Independent Health (Buffalo, NY)
- …Specialist will be responsible for sales acquisition and retention strategies for Medicare . They will be responsible for identifying, contacting, and following up ... with prospects in the Medicare market. They will staff Independent Health ...metrics are met. The Specialist will be responsible for compliance /adherence to CMS sales and marketing guidelines. They must… more