- Walgreens (Dallas, TX)
- …billing and submission of claims to government- sponsored health care programs, including Medicare , Medicaid , and all other third-party payers, as well as the ... bodies and contracts with payers and pharmaceutical manufacturers (BOP, DEA, Medicare , accreditation bodies, compounding, FDA, etc.). + Complies with all federal… more
- Texas Health Resources (Arlington, TX)
- …Care Management Staff, Physicians and other hospital disciplines as required/designated regarding Medicare , Medicaid and Commercial payer guidelines. + Reviews ... Medicare one day stays and conducts medical necessity internal audits (100% one day stays) Additional perks of being a Texas Health employee + Benefits include 401k, PTO, medical, dental, Paid Parental Leave, flex spending, tuition reimbursement, Student… more
- AccentCare, Inc. (Tacoma, WA)
- …+ Experience in dealing with a variety of payors in healthcare, eg, Medicare , Medicaid , and commercial payers, preferred Responsiblities + Collaborates and ... EMR portal. + Where applicable, reviews Eligibility Alerts and Responses for Medicare Clients. + Requests, H&P, Discharge Summary, and other documents needed for… more
- Humana (Santa Fe, NM)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... their respective functions with a focus on Provider Engagement, Quality and Medicare Risk Adjustment. The RVP, Network Performance represents the health plan… more
- Gentiva (Auburndale, MA)
- …patient care coordination * Strong understanding of hospice principles, industry regulations ( Medicare , Medicaid , JCAHO, ACHC), and best practices * Familiarity ... administrative workflows such as documentation of referrals, DME pickups, Medicare eligibility, insurance verifications, and patient benefit tracking * Coordinate… more
- Cognizant (Annapolis, MD)
- …Director based on the review of clinical documentation in accordance with Medicare , Medicaid , and third-party guidelines. . Effectively document and log ... Reviews can be based on InterQual, Milliman Clinical Guidelines (MCG), Medicare guidelines, and health insurer specific guidelines. . Review retro-authorizations in… more
- Fallon Health (Barnstable, MA)
- …strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid , and PACE (Program of All-Inclusive Care for the ... Program policies and processes o Knowledge of and compliance with HEDIS and Medicare 5 Star measure processes, performing member education, outreach, and actions in… more
- AccentCare, Inc. (Sacramento, CA)
- …+ Experience in dealing with a variety of payors in healthcare, eg, Medicare , Medicaid , and commercial payers, preferred. Responsibilities: + Collaborates and ... EMR portal. + W here applicable, reviews Eligibility Alerts and Responses for Medicare Clients. + Requests, H&P, Discharge Summary, and other documents needed for… more
- Humana (Boston, MA)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... reviewing criteria to ensure appropriateness of care preferred + Previous Medicare experience a plus + Milliman MCG experience preferred **Additional Information**… more
- Actalent (Little Ferry, NJ)
- …Bilingual in Spanish/English preferred. + Prior insurance verification experience with Medicare , Medicaid , and private insurance. Additional Skills & ... Bright Tree System to navigate NJ HMO websites, commercial insurance portals, and Medicare systems. + Contact insurance providers to verify benefits and coverage. +… more